The Irish College of General Practitioners (ICGP) has issued an addendum3 to Working with opiate users in community based primary care,4 the best practice guidelines published in 2008. The addendum clarifies four items in the guidelines, as follows:

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• To the sentence ‘Increments should be no greater than 10mg at a time’ is added ‘total dose increases should not exceed 20-30mg in one week’.

• The sentence ‘Patients usually stabilise on doses between 60mg to 80mg’ is changed to ‘Patients usually stabilise on doses between 60mg to 120mg’. The ICGP states that this change is in line with international best practice, but they recommend that ‘this statement is read in the context of the complete section on commencing doses’.

• The sentence starting ‘Higher doses of methadone (>80mg) may be required…’ is changed to ‘Higher doses of methadone may be required...’. The ICGP states: ‘It is not intended to suggest that >80mg would be interpreted as a high dose.’

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• A similar rationale relating to dosage applies to the sentence starting ‘If a patient requires a dose >80mgs and you have limited experience ...’ , which is now changed to ‘If a patient requires a higher dose and you have limited experience ...’.

These changes will be made to the on-line version of the guideline document only, as new national guidelines on opiate treatment are currently being developed by a group comprising representatives of the HSE, the ICGP, the Irish College of Psychiatrists and the Pharmaceutical Society of Ireland.