Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus

Abstract

Management of patients with opioid use disorder (OUD) commonly includes opioid agonist therapy (OAT) as a part of an integrated treatment plan. These interventions are associated with proven benefits to the individual and society. Areas covered: The use of methadone and buprenorphine within an integrated treatment plan in the management of patients with OUD: this work provides consensus recommendation on pharmacotherapy in OUD to assist clinicians with practical decision making in this field. Expert opinion: Pharmacotherapy is recommended as part of an integrated OUD treatment approach with psychosocial interventions, with the goal of reducing risks of illicit opioid use, overdose mortality, infection with HIV or HCV, improving health, psychological and social outcomes. Access to OAT should be prioritised in the treatment of OUD. Treatment choices in OUD pharmacotherapy should be based on the needs of the individual and characteristics of medications. Recommendations for choices of OAT are based on clinical efficacy, safety, patient preference, side effects, pharmacological interactions, quality of life, dose titration potential and outcomes (control craving, ongoing opioids consumption or other drugs, and potentially psychiatric comorbidities). Special groups, pregnant women, prisoners, patients with mental health problems have specific needs which must be addressed with expert input.

Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic

“…There are important safety advantages of buprenorphine over methadone with regards take away or nonsupervised doses, as has been seen in France compared to other countries in Europe [18]. Ideally, buprenorphine may be provided as buprenorphine-naloxone to minimise use by injection.…”

Dopamine and addiction: what have we learned from 40 years of research

“…It should be noted that because of their specific neurobiological characteristics, several authors have proposed targeting the D3R with antagonists and partial to better management of addiction (Newman et al 2012;Le Foll et al 2014). However, no conclusive evidence has been provided by clinical trials (Le Foll et al 2014) The case for the use of dopaminergic agonists in the management of addiction to psychostimulants is much stronger (Herin et al 2010) and it is supported by parallels in opiate and nicotine addiction in which substitution therapy with opioid agonists such as methadone and buprenorphine (Dematteis et al 2017) and nicotine replacement therapy (Haustein 2000;Etter and Stapleton 2006) have been proven to be relatively effective. Direct agonist of dopaminergic receptors do not appear to present the best pharmacological profile, do not appear to stimulate the reward system strongly enough and may produce unwanted effects such as impulsivity (Kim et al 2015).…”

Acute pain management in patients with opiate maintenance treatment in primary care: a qualitative study

“…However, despite these limitations, management of pain in opiate-dependent patients on OMT corresponds to the central core of general practice. GPs have to be involved in patient follow-up, to improve access to OMT and a patient-centred program, as recommended by European consensus (27). One GP mentioned developing a closer relationship with the patient through managing the patient's pain, with an evaluation centred on the patient, including variables not directly linked to opiate-dependence.…”