A free alternative to methadone has been introduced but medical professionals say the dose is not high enough.

Two years ago, Family Minister Michael Falzon announced a pilot project where the tablet buprenorphine would be given to people with heroin use disorder instead of methadone. 

Last week, the health ministry added 0.4 mg buprenorphine to the Government Formulary List, meaning it will now be free for those with a prescription.

Buprenorphine was introduced as an alternative because, unlike methadone, patients do not need to visit a clinic daily, as they can be given more than one tablet at a time.

A doctor with a special interest in addictions told Times of Malta buprenorphine is considered a safer alternative to methadone.

"While both are opiates and are approved to be used as substitution therapy in people with a heroin use disorder, buprenorphine is less likely to cause respiratory depression and possible death from overdose if misused.”

While buprenorphine is not for everyone, the doctor maintained the tablets would benefit around 100 people.

There are currently around 700 people on methadone.

Buprenorphine has been available in Malta for several years and is sold in private pharmacies in 0.4 mg, 2.0 mg, and 8 mg tablets, but most patients could not afford to buy it and preferred to stay on the free methadone. 

While still cheaper than heroin, buprenorphine would set back a user between €150 and €180 per month. 

The doctor said: “The 0.4 mg dose being made available for free is a joke. Keeping in mind one does not just swallow these tablets but wait for them to dissolve in the mouth, this will put people off.”

Aloisia Camilleri, a consultant psychiatrist with a special interest in addictions, said an average low dose of buprenorphine is 4 mg, which is 10 times the dosage being offered by the government.

Camilleri said that a patient needing mental health services and other addiction services would normally need a bigger dose. She said the people who use the services are dealing with a serious problem and need the correct dose to match it. 

“You could say that buprenorphine is a medication that treats withdrawals but it is also a maintenance treatment to prevent relapse into heroin use. The recommended dose should be enough to treat cravings – this dose is usually higher than that needed to treat withdrawal symptoms,” said Camilleri. 

Questions sent to the family ministry and health ministry remained unanswered.