The Pharmaceutical Journal
Vol 278 No 7436 p98
27 January 2007

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Methadone, buprenorphine and naltrexone recommended by NICE

Methadone should be chosen over buprenorphine for the management of opioid dependence if both drugs are equally suitable, according to the National Institute for Health and Clinical Excellence. In a technology appraisal, published by the institute this week, NICE says that oral formulations of methadone and buprenorphine are recommended as options for maintenance therapy, administered daily, under supervision for the first three months of treatment and as part of a programme of supportive care.

“The decision about which drug to use should be made on a case by case basis, taking into account a number of factors, including the person’s history of opioid dependence, their commitment to a particular long-term management strategy, and an estimate of the risk and benefits of each treatment,” the appraisal document states.

In a separate appraisal, NICE recommends naltrexone as a treatment option for formerly opioid-dependent people who are detoxified and highly motivated to remain in an abstinence programme.

NICE says that people being treated with naltrexone should be regularly reviewed and discontinuation of treatment should be considered if there is evidence of opioid misuse.