Changes in opiate treatment during attendance at a community drug service - findings from a clinical audit

To evaluate use of methadone and dihydrocodeine prescription in a group of opiate-dependent patients attending a community/general practice drugs project data were recorded at enrolment in 1990 and at the beginning of 1995. Two hundred individuals were included, of whom 85% were receiving a prescription for an opiate and/or a benzodiazepine. There were no major differences between the groups receiving methadone and dihydrocodeine and retention in treatment, death rate and behaviour change was similar in both groups. Trends during the study period included an increase in methadone prescribing and towards longer-acting benzodiazepines. The slightly different effects of dihydrocodeine compared to methadone made it the opiate of choice for many and may indicate a useful addition to the longer-acting methadone. This may make it an alternative to the current experimenting with heroin, dextromoramide (palfium) and injectable methadone for opiate users resistant to control with oral methadone alone.