Abstract
Opioid dependence is the substance use disorder with the highest mortality, and most drug-related overdose deaths are related to opioid use. Abstinence rates following psychosocial interventions hardly exceed 20–30%. Opioid maintenance treatment is the first-line treatment in opioid dependence reducing psychiatric and somatic morbidity. Besides the full opioid agonist methadone being the gold standard for treatment, the partial agonist buprenorphine is licenced for treatment of opioid dependence. Buprenorphine differs significantly from methadone in its pharmacology, side effects and safety issues. Besides heroin substitution, morphine sulphate has been established as second-line treatment. More recently, the emergency use of naloxone to reduce risk of opioid overdose death has been established, and two novel long-acting depot and implant buprenorphine formulations are close to clinical use.
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