Methadone remains the main treatment of the national health service for the management of opiate dependence. The main alternative drug for management of opiate dependence is buprenorphine1, used increasingly in the NHS since the Department amended regulations in April 2001 to enable practitioners to prescribe the drug for opiate dependence safely through instalment dispensing.
Patients may also be prescribed pharmaceutical diamorphine, and in a small number of cases alternative opiates such as clonidine and lofexidine to substitute for illicit opiate use, with decisions based on clinical judgement for each particular case.
As part of the Government's ongoing commitment to ensuring drug treatment is delivered in a way that maximises the potential for a successful outcome, the National Institute of Health and Clinical Excellence is currently conducting a review of the effectiveness of methadone, buprenorphine and naltrexone in the treatment of drug misusers, due for publication in March 2007.
Although outcomes generally are better for those who remain on opiate substitution treatment, there has been an increase in focus on commissioning effective support for patients who are ready to benefit from abstinence-based approaches to optimise such treatment pathways. Rehabilitation services or aftercare support are available for those opiate-dependent drug users who can successfully become drug-free and who no longer require treatments such as methadone.
1 Marketing Authorisation, Subutex