Opioid Dependence — MRCPsych Paper B MCQ

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EasySubstance MisuseOpioid DependenceMRCPsych Paper B

A 35-year-old man with opioid dependence injects heroin daily and requests opioid substitution maintenance treatment. Following individual assessment and discussion with him, methadone and buprenorphine are judged to be equally suitable, and he has no preference between them. According to NICE TA114, which medication should be prescribed as the first choice?

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Correct answer: E — Methadone

Methadone is correct. NICE TA114 recommends both oral methadone and buprenorphine as options for opioid-dependence maintenance therapy, with the choice made individually in consultation with the patient. When their risks and benefits are judged equal, methadone is the first choice. Buprenorphine remains an appropriate alternative when individual clinical factors or patient preference favour it. Naltrexone is an opioid antagonist used after detoxification to support abstinence in selected, highly motivated patients; it is not substitution therapy. Lofexidine is a non-opioid option used selectively to manage withdrawal during detoxification. Dihydrocodeine is not a recommended routine maintenance treatment and NICE advises against its routine use even in opioid detoxification.

Reference: National Institute for Health and Care Excellence. Methadone and buprenorphine for the management of opioid dependence, TA114, recommendations 1.1–1.3. 2007. https://www.nice.org.uk/guidance/ta114/chapter/1-Guidance