There is not a case to replace methadone by buprenorphine
I must disagree with Jason Lunty et al editorial saying methadone
needs to be replaced by buprenorphine and question much of their case in
favour of this. Methadone maintenance is one of the most successful,
evidence treatments that we have in medicine today and if used correctly
is both effective and safe. It has been available for many, many years and
has saved many thousands of lives worldwide.
Buprenorphine in contrast has
only been licensed for use in treatment of dependence in UK since 1999,
although longer in some other countries and is the only drug licensed for
drug dependence in the UK for the last 25 years (compare this with
diabetes). It is not unusual that here in the UK, where on the whole we
use methadone sub-optimally, buprenorphine is seen as the solution to our
problems – ‘the new kid on the block’. The evidence for it being as
effective for maintenance is not there, even the 2 references that Lunty
uses to support buprenorphine maintenance (his references 7 and 9) state
that methadone is more effective. Buprenorphine ALONE may be a little
safer in overdose but most drug users in the UK are now poly-drug users
and there is no evidence that buprenorphine in combination with alcohol,
cocaine and benzodiazepines is any safer than methadone in this
combination. Plus don’t forget the highest death rate in people who use
drugs is post detoxification. Many people, including RCGP, NTA and DH have
worked hard over the past 15 years to improve treatment for people, please
don’t let this one opinion based editorial damage that improvement.
Rapid Response:
There is not a case to replace methadone by buprenorphine
I must disagree with Jason Lunty et al editorial saying methadone
needs to be replaced by buprenorphine and question much of their case in
favour of this. Methadone maintenance is one of the most successful,
evidence treatments that we have in medicine today and if used correctly
is both effective and safe. It has been available for many, many years and
has saved many thousands of lives worldwide.
Buprenorphine in contrast has
only been licensed for use in treatment of dependence in UK since 1999,
although longer in some other countries and is the only drug licensed for
drug dependence in the UK for the last 25 years (compare this with
diabetes). It is not unusual that here in the UK, where on the whole we
use methadone sub-optimally, buprenorphine is seen as the solution to our
problems – ‘the new kid on the block’. The evidence for it being as
effective for maintenance is not there, even the 2 references that Lunty
uses to support buprenorphine maintenance (his references 7 and 9) state
that methadone is more effective. Buprenorphine ALONE may be a little
safer in overdose but most drug users in the UK are now poly-drug users
and there is no evidence that buprenorphine in combination with alcohol,
cocaine and benzodiazepines is any safer than methadone in this
combination. Plus don’t forget the highest death rate in people who use
drugs is post detoxification. Many people, including RCGP, NTA and DH have
worked hard over the past 15 years to improve treatment for people, please
don’t let this one opinion based editorial damage that improvement.
Competing interests:
None declared
Competing interests: No competing interests