***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Rationale Buprenorphine may be a useful alternative option to methadone in addicts . Opioids can produce severe changes in the immune system . Objectives The objectives of this study are to compare the effect of sublingual buprenorphine and methadone on the immune system and to compare the two substances on the drying-out program compliance . Methods We studied 62 r and omized out patients for a period of 12 months . Subjects ( 55 males and 7 females ; mean age 25±4 years ; average history of heroin abuse being 2 years ) on maintenance treatment were assigned in two groups ( A and B ) . Methadone chloride ( medium dose 100 mg/day ) was administered to group A , whereas group B received sublingual buprenorphine ( 32.40±2.8 mg/day ) . Urine toxicological screening , plasma levels of TNF-alpha interleukin-1 , interleukin-beta , lymphocyte CD14 and a self-rating depression question naire were measured . Results Urine screening was negative for opiates in 17.6 % of group A and in 10.7 % of group B ( p<0.001 ; r=0.62 ) . Depression score was 62±2 in group A and 55±3 in group B ( p<0.01 ) . Cytokine and CD14 revealed higher concentrations both in groups A and B without significant differences ( p>0.05 ) between the two groups . Conclusions The effects of buprenorphine and methadone tested on the immune system were overlapping in our patients . The elevated cytokine levels observed may suggest that the two drugs stimulate immunologic hyperactivation of an immune system that was formerly inhibited by heroin . Furthermore , our data suggest that buprenorphine can be a valid alternative to methadone in maintenance treatment of chronic heroin abuse and referred a marked decline in depression Patients on methadone maintenance therapy  are relatively intolerant of pain , a finding hypothesized to reflect a hyperalgesic state induced by chronic opioid administration . To explore if the intrinsic activity of the opioid maintenance agent might affect expression of hyperalgesia in this population , withdrawal latency for cold-pressor ( CP ) pain was compared between small groups of methadone-maintained ( n = 18 ) , buprenorphine-maintained ( n = 18 ) , and matched control ( n = 18 ) subjects . The opioid-maintained groups had equal and significantly shorter withdrawal latencies than controls , however it is possible that high rates of continued illicit opioid use precluded finding differences between methadone and buprenorphine groups . Differential effects of maintenance agent were found for the few subjects without illicit opioid use , such that withdrawal latencies for methadone-maintained ( n = 5 ) were less than for buprenorphine-maintained ( n = 7 ) which were less than controls ( n = 18 ) . Diminished pain tolerance in patients receiving opioid maintenance treatment  has significant clinical implication s. More research is needed to determine if buprenorphine offers advantages over methadone in this regard Methadone medical maintenance ( MMM ) reduces the reporting schedule for stable and well-functioning methadone maintenance patients to once a month , with counseling provided by medical staff . We report on the 12-month outcomes of 92 highly stable methadone maintenance patients r and omly assigned to one of three study conditions : routine care , MMM at the methadone maintenance program , and MMM at a physician 's office . Methadone medical maintenance patients received a 28-day supply of methadone , whereas  routine care patients  received five or six take-home methadone doses each week . All patients performed a medication recall once a month and su bmi tted two urine sample s each month . An adaptive stepped-care system of treatment intensification was used for patients who failed recall or who had drug-positive urine specimens . Seventy-seven patients completed the 12-month study period .  Dropout was caused primarily by problems with h and ling methadone and disliking the recall frequency . There were low rates of drug use or failed medication recall . Treatment satisfaction was high in all groups , but the MMM patients initiated more new employment or family/social activities than did routine care patients over the study period . The stepped-care approach was well tolerated and matched patients to an appropriate step of service within a continuum of treatment intensity Abstract Background Buprenorphine dependence is a relatively novel addiction . Aims To compare the treatment outcome in three groups over 12-weeks of treatment . Methods Two hundred and four intravenous (IV)-buprenorphine-dependent patients were r and omised into three groups . Subjects received 50 mg oral methadone tablet , or 5 mg sublingual buprenorphine tablet , or 50 mg oral naltrexone , and a weekly 30-minute clinical counselling session . Results The majority ( 80 % ) had a history of opium or heroin dependency before they were introduced to IV buprenorphine . The main source of buprenorphine for misusers was street sale ( 91 % ) . The mean duration of buprenorphine dependence was 1.9 years and the mean dose per day was 3.9 ampoules ( 1 ampoule contains 0.3 mg of buprenorphine in 1ml ) . Overall 59 % of the patients completed the 12-week study . Retention in the 50 mg methadone group was significantly better than the 5 mg dose buprenorphine group ( p=0.001 ) and the 50 mg dose naltrexone group ( p=0.000 ) . Retention in the 5 mg buprenorphine group was significantly better than the 50 mg naltrexone dose group ( p=0.000 ) . Conclusions These results support the efficacy and safety of oral methadone and sublingual buprenorphine tablets for injection buprenorphine-dependent patients BACKGROUND The partial opiate-receptor agonist buprenorphine has been suggested for treatment of heroin dependence , but there are few long-term and placebo-controlled studies of its effectiveness . We aim ed to assess the 1-year efficacy of buprenorphine in combination with intensive psychosocial therapy for treatment of heroin dependence . METHODS 40 individuals aged older than 20 years , who met DSM-IV criteria for opiate dependence for at least 1 year , but did not fulfil Swedish legal criteria for methadone maintenance treatment were r and omly allocated either to daily buprenorphine ( fixed dose 16 mg sublingually for 12 months ; supervised daily administration for a least 6 months , possible take-home doses thereafter ) or a tapered 6 day regimen of buprenorphine , thereafter followed by placebo . All patients participated in cognitive-behavioural group therapy to prevent relapse , received weekly individual counselling sessions , and su bmi tted thrice weekly supervised urine sample s for analysis to detect illicit drug use . Our primary endpoint was 1-year retention in treatment and analysis was by intention to treat . FINDINGS 1-year retention in treatment was 75 % and 0 % in the buprenorphine and placebo groups , respectively ( p=0.0001 ; risk ratio 58.7 [ 95 % CI 7.4 - 467.4 ] ) . Urine screens were about 75 % negative for illicit opiates , central stimulants , cannabinoids , and benzodiazepines in the patients remaining in treatment . INTERPRETATION The combination of buprenorphine and intensive psychosocial treatment is safe and highly efficacious , and should be added to the treatment options available for individuals who are dependent on heroin AIMS To evaluate the effectiveness of buprenorphine compared with methadone maintenance therapy in opiate addicts over a treatment period of 24 weeks . DESIGN Subjects were r and omized to receive either buprenorphine or methadone in an open , comparative study . SETTING Subjects were recruited and treated at the drug addiction outpatient clinic at the University of Vienna . PARTICIPANTS Sixty subjects ( 19 females and 41 males ) who met DSM-IV criteria for opioid dependence and were seeking treatment . INTERVENTION Subjects received either sublingual buprenorphine ( 2-mg or 8-mg tablets ; maximum daily dose 8 mg ) or oral methadone ( racemic D -/+ L-methadone ; maximum daily dose 80 mg ) . A stable dose was maintained following the 6-day induction phase . MEASUREMENT Assessment of treatment retention and illicit substance use ( opiates , cocaine and benzodiazepines ) was made by urinalysis . FINDINGS The retention rate was significantly better in the methadone maintained group ( p < 0.05 ) but subjects completing the study in the buprenorphine group had significantly lower rates of illicit opiate consumption ( p = 0.04 ) . CONCLUSION The results support the superiority of methadone with respect to retention rate . However , they also confirm previous reports of buprenorphine use as an alternative in maintenance therapy for opiate addiction , suggesting that a specific subgroup may be benefiting from buprenorphine . This is the first comparative trial to use sublingual buprenorphine tablets : previously published comparison studies refer to 30 % solutions of buprenorphine in alcohol BACKGROUND Prescription opioid dependence is a growing problem , but little research exists on its treatment , including patient characteristics that predict treatment outcome . METHODS A secondary analysis of data from a large multisite , r and omized clinical trial , the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study ( POATS ) was undertaken to examine baseline patient characteristics ( N=360 ) associated with success during 12-week buprenorphine/naloxone treatment for prescription opioid dependence . Baseline predictor variables included self-reported demographic and opioid use history information , diagnoses assessed via the Composite International Diagnostic Interview , and historical opioid use and related information from the Pain And Opiate Analgesic Use History . RESULTS In bivariate analyses , pre-treatment characteristics associated with successful opioid use outcome included older age , past-year or lifetime diagnosis of major depressive disorder , initially obtaining opioids with a medical prescription to relieve pain , having only used opioids by swallowing or sublingual administration , never having used heroin , using an opioid other than extended-release oxycodone most frequently , and no prior opioid dependence treatment . In multivariate analysis , age , lifetime major depressive disorder , having only used opioids by swallowing or sublingual administration , and receiving no prior opioid dependence treatment remained as significant predictors of successful outcome . CONCLUSIONS This is the first study to examine characteristics associated with treatment outcome in patients dependent exclusively on prescription opioids . Characteristics associated with successful outcome after 12 weeks of buprenorphine/naloxone treatment include some that have previously been found to predict heroin-dependent patients ' response to methadone treatment and some specific to prescription opioid-dependent patients receiving buprenorphine/naloxone Ninety-six confirmed heroin addicts requesting a heroin maintenance prescription were r and omly allocated to treatment with injectable heroin or oral methadone . Progress was monitored throughout the next 12 months by research workers operating independently of the clinic . Heroin can be seen as maintaining the status quo , with the majority continuing to inject heroin regularly and to supplement their maintenance prescription from other sources ; it was associated with a continuing intermediate level of involvement with the drug subculture and criminal activity . Refusal to prescribe heroin while offering oral methadone constituted a more confrontational response and result ed in a higher abstinence rate , but also a greater dependence on illegal sources of drugs for these who continued to inject . Those offered oral methadone tended to polarize toward high or low categories of illegal drug use and involvement with the drug subculture , and were more likely to be arrested during the 12-month follow-up . There was no difference between the two groups in terms of employment , health , or consumption of nonopiate drugs . Refusal to prescribe heroin result ed in a significantly greater drop out from regular treatment AIMS To evaluate the safety and efficacy of an 8 mg/day sublingual dose of buprenorphine in the maintenance treatment of heroin addicts by comparison with a 1 mg/day dose over a 16-week treatment period . As a secondary objective , outcomes were determined concurrently for patients treated with two other dose levels . DESIGN Patients were r and omized to four dosage groups and treated double-blind . SETTING Twelve outpatient opiate maintenance treatment centers throughout the United States . PARTICIPANTS Two hundred and thirty-nine women and 497 men who met the DSM-III-R criteria for opioid dependence and were seeking treatment . INTERVENTION Patients received either 1 , 4 , 8 or 16 mg/day of buprenorphine and were treated in the usual clinical context , including a 1-hour weekly clinical counseling session . MEASUREMENT Retention in treatment , illicit opioid use as determined by urine toxicology , opioid craving and global ratings by patient and staff . Safety outcome measures were provided by clinical monitoring and by analysis of the reported adverse events . FINDINGS Outcomes in the 8 mg group were significantly better than in the 1 mg group in all four efficacy domains . No deaths occurred in either group . The 8 mg group did not show an increase in the frequency of adverse events . Most reported adverse effects were those commonly seen in patients treated with opioids . CONCLUSIONS The findings support the safety and efficacy of buprenorphine and suggest that an adequate dose of buprenorphine will be a useful addition to pharmacotherapy Buprenorphine at 2 mg and 6 mg daily was 
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Studies evaluating illicit opioid consumption using other measures demonstrate pain to increase the risk for opioid abuse .
Conclusion CNCP may increase risk for continued opioid abuse and poor psychiatric functioning .