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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MeReC Bulletin - Opiate Dependence

The National Prescribing Centre (NPC) has published a MeReC Bulletin (PDF) that provides an update on the drug treatment of opiate dependence in primary care.

The bulletin provides a background to scale of opiate dependence detailing the physical and mental health problems as well as the wider social problems associated with illicit drug use. The bulletin also defines the aims and principles of treatment and a discussion of the evidence supporting maintenance and detoxification.

The current guidance from the National Institute for Health and Clinical Excellence is summarised into several key points:

  • Methadone and buprenorphine (oral formulations), using flexible dosing regimens, are recommended as options for maintenance therapy in the management of opioid dependence
  • The decision about which drug to use should be made on a case-by-case basis
  • If both drugs are equally suitable, methadone should be prescribed as the first choice
  • Methadone and buprenorphine should be administered daily, under supervision, for at least the first 3 months. Supervision should be relaxed only when the patient's compliance is assured
  • Both drugs should be given as part of a programme of supportive care

Finally, the bulletin identifies sources of evidence that support 'real life' benefits of treatment programmes and details the potential risks of drug treatment.

Action: Clinicians involved in the treatment of patients with opiate dependence will find this bulletin useful and informative.

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