Buprenorphine and methadone are both effective medications for the treatment of opioid dependence. Historically, methadone was seen as the ‘gold standard’ in treatment but buprenorphine is also clinically effective, cost-effective and recommended by the National Institute for Health and Care Excellence (NICE). Patients still have limited treatment options in terms of licensed medications for opioid substitution when compared to the treatment of other mental health conditions.
So why use buprenorphine as a prescribing option in opioid dependence?
Buprenorphine is a NICE-approved treatment for both maintenance and detoxification in opioid dependence. It provides an important alternative to methadone and has similar efficacy in maintenance. Buprenorphine is associated with reduced risk of fatal overdose in the first weeks of titration, whereas methadone is likely to be more effective in retaining patients in treatment, and so choosing the appropriate opioid substitute is a very important discussion to have with patients. It has also been widely accepted that buprenorphine provides superior results when used for detoxification from opioids, compared to methadone or lofexidine (Gowing, 2009). However, the relapse rates in the year post-detoxification remain high, whatever the method of detoxification.
This module will help you gain confidence in the use of buprenorphine for both the maintenance and detoxification phases when treating opioid dependence.
Learning objectives:
By the end of the module, you should be able to:
• understand how buprenorphine works and the preparations available
• assess the appropriateness of buprenorphine prescribing in both maintenance and detoxification
• safely induct someone onto buprenorphine and titrate the does to an effective level in maintenance treatment
• detoxify someone who is opioid dependent using buprenorphine.
