The Netherlands Drug Situation 2010 - Trimbos-instituut

Name of Assessors: André van Gageldonk, Trimbos Institute,Netherlands Institute of Mental Health and Addiction1. Choice of treatment 11.2 For the pharmacological treatment of opioid dependence,clinicians should offer opioid withdrawal, opioid agonistmaintenance and opioid antagonist (naltrexone) treatment,but most patients should be advised to use opioid agonistmaintenance treatment.Do the present guidelines include this recommendation?1.3 For opioid-dependent patients not commencing opioidagonist maintenance treatment, consider antagonist pharmacotherapyusing naltrexone following the completion ofopioid withdrawal.Do the present guidelines include this recommendation?YesNoNot ApplicablespecifyNo ans-X □ □ □X □ □ □2 Opioid agonist maintenance treatment □ □ □ □2.1 For opioid agonist maintenance treatment, most patientsX 2should be advised to use methadone in adequate doses inpreference to buprenorphine.Do the present guidelines include this recommendation?2.2 During methadone induction, the initial daily dose should □ X 3 □ □depend on the level of neuroadaptation; it should generallynot be more than 20 mg, and certainly not more than30mg.Do the present guidelines include this recommendation?2.3 On average, methadone maintenance doses should be in □ X □ □the range of 60–120 mg per day.Do the present guidelines include this recommendation2.4 Average buprenorphine maintenance doses should be at □ X □ □least 8 mg per day.Do the present guidelines include this recommendation?2.5 Methadone and buprenorphine doses should be directly supervised□ □ X 4 □in the early phase of treatment.Do the present guidelines include this recommendation?2.6 Take-away doses may be provided for patients when the X □ □ □benefits of reduced frequency of attendance are consideredto outweigh the risk of diversion, subject to regular review.Do the present guidelines include this recommendation?1 Both 1.2 and 1.3 are not explicitly recommended, but the standard detoxification (withdrawal) treatment inthe Netherlands is with methadone. Naltrexone was used temporary in an experiment with rapid detoxification.2 Not recommended, but this is a reality in the Netherlands where buprenorphine is not (yet) as regularly usedas methadone. Buprenorphine was only recently registered as a medicine and is paid on medical request bythe health insurance company.3 The recommended starting dosis methadone is 20 mg for patients who do not use often heroin, and 40 mgwhen frequent heroin use is suspected.4 This is not explicitly recommended but implicitly assumed to be present, to be done.176