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NETWORK A national newsletter on substance misuse management in primary care
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I S S U E 1 3 F E B R U A R Y 2 0 0 6
Rationale for the use
Welcome
of methadone
Excerpt from Guidance for the use of methadone for the treatment of opioid
dependence in primary care. RCGP Substance Misuse Unit, RCGP Sex,
Drugs and HIV Task Group, SMMGP, The Alliance, 1
st
Edition 2005 available at
www.smmgp.org.uk
Methadone is an effective substitute medication for opioid dependence
for use in UK primary care.
There is an increasing body of evidence that the primary care setting is an
effective means of delivering treatment for opioid dependence.
10,11,12,13
Methadone
maintenance treatment (MMT) is now a well-established treatment modality across
a variety of treatment settings and supported by both research evidence and clinical
practice.
14,15,16,17,18,19.

The aim of methadone maintenance treatment is to improve the quality of life of It is an exciting time for the updated
opioid-dependent patients and to reduce the potential harm of using illicit drugs. MMT smmgp.org.uk website as we celebrated
greatly reduces mortality,
20
illicit drug use and criminal activity, and attracts and retains
our 100,000th hit in January. With more
more patients in treatment than other treatments.
9
There is good evidence that MMT
than a quadrupling of weekly hits over
reduces transmission of HIV,
21,22,23
although the evidence for effectiveness at reducing
this past year, the site is now receiving
transmission of hepatitis B virus and hepatitis C virus is less convincing.
24,25,26

as many as 2,500 regular home page
hits a week not counting the discussion
There is no evidence that MMT increases the overall length of dependence.
14
The
forums or other routes into the site.
positive outcomes of MMT are only sustained while patients are in treatment. Effective
So take a look, try out the forums or
treatment of the parent can also have major benefits for the children of problem drug
download a conference brochure as we
users.
27

look forward to seeing you shortly in
Manchester for yet another stimulating
Methadone is a highly effective maintenance treatment for chronic dependent opioid
RCGP SMMGP conference on 27th
users that can deliver a wide range of harm reduction outcomes for large numbers
and 28th April – Are we Delivering
of patients in a wide variety of settings. However, effectiveness may be reduced by
Effective Care in General Practice?
departure from optimum methods of delivery. Enforced reductions in the methadone
( www.smmgp.org.uk.)
dose and putting pressure on patients to become abstinent from methadone are
IN THIS ISSUE - We showcase the RCGP
associated with poor outcomes.
28
SMMGP Methadone Guidance on
pages 1-3 with excerpts of the guidance
The most effective MMT programmes are those that provide optimal doses (usually
summary, the rationale for methadone
between 60 to 120mg daily) of methadone as part of a comprehensive treatment
prescribing and advice on when to choose
programme, which will include regular reviews, general medical care and psychosocial
between maintenance and detoxification.
support as required, and which validates maintenance as much as abstinence as
These excerpts also highlight some of the
desirable treatment goals
9, 17, 29
and where patients feel they play a meaningful role in
key treatment principles which primary
determining their optimum dose. care has been keen to promote (See the
full guidance on www.smmgp.org.uk ).
A summary of the evidence in 1999 concluded that given the high morbidity and
mortality seen in patients with opioid dependence not in treatment, the public health
In case you have ever felt lost interpreting
challenge was to deliver safe and effective methadone treatments to as many
your patients’ jargon and the weights
patients as could benefit from it, while minimising the risk of diversion of prescribed
and measures of the illicit drugs scene
medication.
14
Whilst methadone clearly remains the mainstay of the public health
(page 4), Dr Gordon Morse provides
response, there has been an increase recently in the use of buprenorphine for some
some witty and insightful tips courtesy of
patients. Also with more patients now in treatment, increasing access to psychosocial
an ambiguous but seemingly authoritative
source.
and other supportive interventions in addition to the pharmacotherapy is important.

…continued overleaf
continued overleaf
1
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