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Drugs: Rehabilitation

Volume 481: debated on Monday 27 October 2008

To ask the Secretary of State for Health what assessment his Department has made of the effects of the use of suboxone instead of methadone or subutex in prisons. (229880)

Suboxone, methadone and subutex are available on the national health service. The decision to use any drug is a clinical one, taken in the community or in prison following consultation with the patient about their clinical needs and priorities.

In January 2007 the National Institute for Health and Clinical Excellence (NICE) published the Technology Appraisal “Methadone and buprenorphine for managing opioid dependence”, which recommended the use of both methadone and buprenorphine for the treatment of opioid dependence. Such treatments must be funded and provided within the NHS in line with NICE recommendations. However, this appraisal did not consider suboxone which combines buprenorphine and naloxone and subutex which is buprenorphine only, as newer products.

Advice on prescribing of suboxone is contained in “Drug Misuse and Dependence: UK Guidelines on Clinical Management”, which was published jointly by the Department of Health and the National Treatment Agency for Substance Misuse in September 2007. This has already been placed in the Library and can be found at:

http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Substancemisuse/Substancemisusegeneralinformation/DH_4064342

To ask the Secretary of State for Health what assessment he has made of whether suboxone has advantages in terms of reduced potential for diversion and reduced chance of overdose compared with other anti-opiate therapies. (229881)

Suboxone takes the form of a tablet to be placed under the tongue. It is a combination of buprenorphine hydrochloride and naloxone hydrochloride, used in the treatment of opioid dependence.

Buprenorphine stimulates the effects of opioids, such as heroin, and naloxone blocks the effects of opioids.

Suboxone has been designed to limit the potential for its misuse. When it is taken as prescribed, under the tongue, the naloxone has no effect, but if it is misused and injected the naloxone becomes activated and causes withdrawal symptoms, which makes the drug unattractive for misuse.

The decision to use suboxone is a clinical one and is taken following consultation with the patient about their clinical needs and priorities. This principle applies in prisons and the community alike. In prisons all prescribed doses of controlled drugs such as buprenorphine-based drugs and of methadone are administered under closely supervised conditions.

Advice on prescribing of suboxone is contained in “Drug Misuse and Dependence: UK Guidelines on Clinical Management”, which was published jointly by the Department and the National Treatment Agency for Substance Misuse in September 2007. A copy has been placed in the Library and can also be found at:

http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Substancemisuse/Substancemisusegeneralinformation/DH_4064342