New guidance on the management of opioid dependency

The National Institute of Clinical Excellence (NICE) has issued guidance recommending methadone and buprenorphine as options for maintenance therapy in opioid dependency.

New opioid dependency guidance
New opioid dependency guidance

The guidance also recommends naltrexone as a treatment option in detoxified formerly opioid-dependent individuals who are highly motivated to remain free from opioids.

Key recommendations are:

  • The decision about as to whether methadone or buprenorphine is used should be made on a case by case basis, taking into account the person's history of opioid dependence, their commitment to a particular long-term management strategy, and an estimate of the risks and benefits of each treatment made by the responsible clinician in consultation with the person. 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.
  • Naltrexone should only be administered under adequate supervision to people who have been fully informed of the potential adverse effects of treatment. It should be given as part of a programme of supportive care. The effectiveness of naltrexone in preventing opioid misuse in people being treated should be reviewed regularly. Discontinuation of naltrexone treatment should be considered if there is evidence of substance (opioid) misuse.

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