Approved Medications for Substance Use Disorders: An Umbrella Review of Systematic Reviews and Completed Phase 3 Randomized Controlled Trials.
Itai Danovitch, Kyla Truman, Haze Brown et al.
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In 30 seconds
This PROSPERO-registered umbrella review synthesised systematic reviews and completed phase 3 randomised trials of approved and pipeline medications for substance use disorders worldwide. It included 16 systematic reviews covering 371 RCTs (n = 131,965) and 62 observational studies (n = 229,225), plus four phase 3 RCTs with posted results (n = 1026). Across the evidence, approved medications were associated with reduced return to drinking, greater abstinence in opioid and tobacco use disorders, and high survival rates after opioid overdose reversal. The review also identified emerging treatments beyond currently approved options.
Key findings
- For alcohol use disorder, 86 RCTs (n = 18,643) found a 7 to 17% reduction in risk of returning to any drinking versus placebo.
- For opioid use disorder, the highest abstinence rates ranged from 41 to 43%, compared with 5% in placebo.
- For tobacco use disorder, eight medications were associated with 1.3-2.3 times more likelihood of abstinence than placebo.
- Across 41 observational studies of opioid overdose reversal, reported survival rates ranged from 92 to 98%.
Why it matters
The review brings together evidence across multiple substance use disorders and treatment purposes, including ongoing treatment, withdrawal management, and overdose reversal. Its findings indicate that pharmacological options are available for alcohol, opioid, and tobacco use disorders, while phase 3 trials point to potential additions to the treatment landscape. The synthesis may help frame current evidence and areas of ongoing development.
What to keep in mind
The review synthesised studies with differing designs and outcomes, including observational evidence; the reported findings therefore do not represent a single direct comparison across medications.