• Simon Ducharme, Ronald Fraser, and Kathryn Gill.
• Department of Psychiatry, McGill University, Montreal, Que, Canada. simon.ducharme@mail.mcgill.ca
• Can Fam Physician. 2012 Jan 1; 58 (1): 374137-41.

ObjectiveTo review the current evidence on buprenorphine-naloxone for the treatment of opioid-related disorders, with a focus on primary care settings.Quality Of EvidenceMEDLINE and the Cochrane Database of Systematic Reviews were searched. Evidence is mainly level I.Main MessageBuprenorphine is a partial μ-opioid agonist and κ-opioid antagonist with a long half-life and less abuse potential than methadone. For detoxification, buprenorphine is at least equivalent to methadone and is superior to clonidine. For maintenance treatment, buprenorphine is clearly superior to placebo. Methadone has a slight advantage in terms of retention in treatment, but a stepped approach with initial use of buprenorphine-naloxone is as efficacious. Use of buprenorphine in the primary care setting is feasible, safe, and effective. Authorization to prescribe buprenorphine can be obtained after completing online training.ConclusionBuprenorphine is a safe and effective agent for detoxification from opioids. It can be used as a first-line agent in maintenance programs, owing to its lower abuse potential relative to other opioids. Its effectiveness in primary care settings makes it a useful therapeutic tool for family physicians.

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