Is methadone too dangerous for opiate addiction?

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7529.1352 (Published 8 December 2005)
Cite this as: BMJ 2005;331:1352

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  1. Jason Luty, honorary consultant psychiatrist in the addictions (sl006h3607@blueyonder.co.uk),
  2. Colin O'Gara, clinical research fellow in the addictions,
  3. Mohammed Sessay, staff grade in addiction psychiatry
  1. Cambridge and Peterborough Mental Health NHS Trust, Taylor Centre, Southend on Sea, Essex SS4 1RB
  2. National Addiction Centre, Institute of Psychiatry, London, SE5 8BB
  3. Merton Community Drug Team, Department of Addictive Behaviour, St George's Hospital Medical School, London SW17 0RE

    The case for using a safer alternative, buprenorphine, is strong

    Methadone is an effective treatment for heroin addiction, and it remains the mainstay of drug treatment for opiate dependence in the United Kingdom.1 The lethal dose of methadone is estimated at 50 mg for an opiate-naive adult.2 Nevertheless, many authorities recommend that methadone doses should be gradually increased to maintenance doses of 80-120 mg1—that is, twice the lethal dose for non-users. The greatly increased risk to users from methadone, particularly black market methadone, thus remains a major concern. Buprenorphine is a partial agonist that has a lower potential for causing respiratory depression than many other opioids, including methadone and heroin.3 It is increasingly used in the United Kingdom to treat opiate dependence, with guidelines for clinical management in primary and secondary care summarised by Ford et al4 and Taikato et al.5 It is time it replaced methadone as the mainstay of drug treatment for opiate dependence.

    A long running debate continues …

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