Addressing unmet needs in opiate dependence: providing better support for detoxification from OST and advances in relapse prevention

Abstract

Despite the record breaking levels of opiate related deaths published this year in the UK, pharmacological management of opioid dependence has evolved little since the advent of methadone in 1965. Along with harm minimisation and psychosocial interventions, the mainstay of pharmacological treatment remains opiate substitution therapy (OST) using methadone or buprenorphine, with many patients receiving OST for many years. Even with these treatments, opiate users continue to face mortality risks of 12 times higher than the general population, and emerging evidence suggests that patients who remain on long-term OST present with a range of physical and cognitive impairments. Therefore, with a growing ageing opiate dependent population who would benefit from detoxification from OST, this article will provide an overview of the current situation regarding opioid abuse and current clinical practice, will explore the reasons why availability and acceptability of detoxification pathways are declining, and will discuss emerging pharmacological therapies that could provide benefit in relapse prevention.