The National Institute for Health and Clinical Excellence (NICE) has issued guidance for the NHS in England and Wales recommending methadone and buprenorphine as options for maintenance therapy in the management of opioid dependence, and naltrexone as a treatment option in detoxified formerly opioid-dependent people who are highly motivated to remain free of opioids.
NICE recommends that: • The decision 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-termstrategy, 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 three 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 opiod misuse in people being treated should be reviewed regularly. Discontinuation of naltrexone treatment should be considered if there is evidence of substance (opioid) misuse.
