Suboptimal dosing of opioid agonist treatments - a literature review

Background: Opioid Agonist Treatments (OAT) are used to help with the treatment of patients with issues of dependence to opioid substances. These medications (methadone and buprenorphine) have therapeutic ranges which are commonly referenced and referred to in text and guidelines. Suboptimal dosing (i.e. dosing below the therapeutic level) has been recorded in a few texts. Suboptimal dosing can have an effect on the successive treatment, especially if there are no clear reasons for this (valid reasons can be up titration of dose and detoxification). Methods: This paper looks at the published literature to determine the common prevalence of sub optimal doses of OAT. Results: A limited number of texts were identified that looked at sub optimal dosing in population groups. The results varied between papers but showed a high degree of low dosing. The review also looked at differences between prescribing of methadone and buprenorphine to determine if the medications have a difference between suboptimal rates. Conclusions: Suboptimal dosing for OAT found in the papers is common place in substance misuse services within the UK.