# Medicine choices in opioid substitution treatment

Source: https://www.keypedia.com/records/uk_mhra_guidance/uk-mhra/8a96fa05-62f5-4f88-9fcc-a314fa496588
Type: Guidance
Published: December 27, 2024

> The UK Department of Health and Social Care (DHSC) has issued supplemental clinical guidance to update the 2017 Orange Book regarding opioid substitution treatment. This update, developed by a clinical expert group, addresses changes in evidence and practice since the previous standards were set. The regulatory framework relies on existing National Institute for Health and Care Excellence (NICE) guidelines, including CG52 for detoxification and TA114 for methadone and buprenorphine management. While the document does not report on specific company inspections or violations, it addresses the issue of outdated protocols by providing refined instructions for prescribing oral methadone and buprenorphine. Required actions for medical practitioners involve integrating this supplementary guidance with original Orange Book protocols when treating opioid dependence. This ensures that prescribing practices for substitute medications remain current and evidence-based. Furthermore, the DHSC announced that specific guidance regarding long-acting buprenorphine injections will be released in 2025. Clinicians are expected to adhere to these updated standards to maintain high levels of care and safety in substance misuse management across the United Kingdom.

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## Content

The main clinical guidance for treating people with opioid dependence is Drug misuse and dependence: UK guidelines on clinical management (the Orange Book), which references the following National Institute for Health and Care Excellence ( NICE ) guidelines: Drug misuse in over 16s: opioid detoxification (CG52) Methadone and buprenorphine for the management of opioid dependence (TA114) However, since the Orange Book was published in 2017, there have been developments that have led to a need for further guidance. The Department of Health and Social Care convened a clinical expert group to consider recent evidence and clinical experience, and advise on further guidance to supplement that in the Orange Book. This guidance on opioid substitution treatment is based on the expert group’s recommendations. Clinicians should use this guidance, alongside the Orange Book, to inform their prescribing of oral methadone and buprenorphine as substitute medication to people who are in treatment for opioid dependence. Further guidance on buprenorphine long-acting injections will be published in 2025.

## Attachments

- [Oral methadone and buprenorphine: recommendations](/government/publications/medicine-choices-in-opioid-substitution-treatment/oral-methadone-and-buprenorphine-recommendations)