NICE issues guidance on opioid dependence drugs

The National Institute for Health and Clinical Excellence (NICE), the UK advisory body responsible for evaluating the effectiveness of drugs and clinical treatments in England and Wales, has recommended 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 from those agent, a class of drugs that can include heroin, opium and morphine.

The agency stated that the decision on 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 three months. Supervision should be relaxed only when the patient's compliance is assured. Both drugs should be given as part of a program of supportive care, noted the NICE.