BMJ editorial on whether methadone is outdated and ought to be replaced by buprenorphine

Is methadone too dangerous for opiate addiction? Luty J, O'Gara C, and Sessay M. BMJ 2005; 331: 1352-1353

Dear Colleagues,

This contentious editorial by Luty, O'Gara and Sessay

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raised much interest in the "rapid response" pages of the web BMJ in late December. There had been 25 replies up to Februrary, which is remarkable.

While a few have agreed with the premise that buprenorphine (pure) should be the drug of choice now for newly presenting heroin addicts, there was a stronger sentiment that methadone is still the best first line drug, with buprenorphine an excellent alternative. Methadone is also much cheaper at present, but this may change as generics are reportedly being introduced (in France and possibly elsewhere) since the patent has expired on high-dose buprenorphine for addiction treatments.

Perhaps as a gesture to the many responses, the journal published two of the early responses in their hard-copy edition only 4 weeks following the original (including one from Byrne Surgery). Numerous specialists have been involved in this BMJ 'debate' - and it is a pity that some of them were not chosen by the BMJ to review this manuscript long before it was published, with its controversial and unsubstantiated suggestions. There were letters from Andrew Ashworth, Chris Ford, Adam Bakker, Richard Hallinan, Gordon Morse, Matthew Hickman, Pier Paolo Pani, Colin Drummond and Jenny Keen.

I hope these reflections are of interest. There is hardly any mention of combination buprenorphine, which seems to be almost off the radar in Europe.

Comments by Andrew Byrne ..