Drug misuse in over 16s: opioid detoxification

Reasons for the decision

No new evidence was identified which suggested NICE guideline CG52 should be updated. Limited ongoing research of relevance was identified, comprising 2 small studies, but these are unlikely to publish in the near future.

Feedback provided from topic experts suggested some areas that need to be reviewed. These areas are pharmacological treatments, treatment of prescription opioid dependence, and psychosocial interventions. Some additional evidence is relevant but does not directly impact on the recommendations and will be addressed through editorial changes. Other suggested changes were not supported by sufficient evidence.

Intelligence and stakeholder feedback indicated the need to assess the benefits of the depot route for buprenorphine (FluidCrystal depot injection [CAM2038] for opioid abuse/dependence), subcutaneous injection of buprenorphine (RBP-6000) and maintenance treatment overall for opioid dependence. This has not been included in this surveillance review because maintenance treatment is covered by the NICE technology appraisal guidance on methadone and buprenorphine for the management of opioid dependence. Furthermore, the NICE medicines team is reviewing evidence for these formulations of buprenorphine with the aim of producing an evidence summary. However, NICE will continue to clarify the broader care pathway for the management of drug misuse and engage with system partners to develop NICE guidance that is comprehensive and accessible. A planned workshop will consider integration of the NICE clinical guidelines on drug misuse; NICE's public health guideline on needle and syringe programmes; technology appraisal guidance for the management of opioid dependence covering methadone and buprenorphine, and naltrexone; and the evidence summary being produced by the NICE medicines team on depot buprenorphine.