Medicine Choices in Opioid Substitution Treatment: Updated Guidance

Introduction:

Opioid dependence remains a significant public health challenge, necessitating effective and evidence-based treatment strategies. The Department of Health and Social Care has convened a clinical expert group to review recent developments and provide updated guidance on opioid substitution treatment (OST). This guidance focuses on the prescribing of oral methadone and buprenorphine, aiming to support clinicians in delivering optimal care for individuals undergoing treatment for opioid dependence.

Key Updates in the Guidance:

Supplementing the Orange Book:
The new guidance serves as an adjunct to the 2017 “Drug Misuse and Dependence: UK Guidelines on Clinical Management” (the Orange Book), incorporating recent evidence and clinical insights to address emerging challenges in OST.

Focus on Methadone and Buprenorphine:
Emphasising the use of oral methadone and buprenorphine, the guidance provides detailed recommendations to assist clinicians in selecting and prescribing these medications based on individual patient needs and circumstances.

Anticipated Guidance on Long-Acting Buprenorphine Injections:
Recognising the evolving landscape of OST, the Department has announced plans to publish further guidance on buprenorphine long-acting injections in 2025, reflecting ongoing advancements in treatment options.

Implications for Clinical Practice:

Clinicians involved in the treatment of opioid dependence should:

Integrate Updated Guidance: Incorporate the new recommendations alongside the existing Orange Book guidelines to inform prescribing practices, ensuring that treatment approaches are aligned with the latest evidence and clinical expertise.

Personalise Treatment Plans: Assess individual patient needs, preferences, and clinical circumstances when selecting between methadone and buprenorphine, tailoring treatment plans to optimise outcomes.

Stay Informed on Emerging Options: Anticipate the forthcoming guidance on buprenorphine long-acting injections and consider how these emerging treatment modalities may be integrated into practice to enhance patient care.

Conclusion:

The updated guidance on medicine choices in opioid substitution treatment represents a significant step toward enhancing the quality and effectiveness of care for individuals with opioid dependence. By supplementing the foundational Orange Book guidelines with recent evidence and clinical insights, the Department of Health and Social Care aims to support clinicians in delivering personalised, evidence-based treatment that addresses the evolving needs of patients.

For detailed information, refer to the official publication: Medicine choices in opioid substitution treatment.