Substitute Prescribing


What is Substitute Prescribing?


CGL Gloucestershire offer two forms of substitute prescribing – methadone and buprenorphine

Methadone is a drug that can be prescribed. Although similar to heroin it lasts a lot longer in the body. If you take methadone you are unlikely to get withdrawal symptoms if you stop heroin (or the withdrawal symptoms will be much less severe).

Espranor is a wafer which is dissolved on the tongue, Espranor attaches to the opiate receptors in the body and blocks the effects of any opiates which are taken on top.


If you take substitute medication, instead of street heroin, under supervision from a doctor you are

  • More likely to be able to get away from the street ‘drug scene’.
  • Likely to feel better in yourself.
  • More likely to be able to get off drugs for good

You will need to be seen first by a drug worker and then by a prescribing doctor. Following assessment, the community drug team may prescribe methadone or espranor.

If you have been injecting drugs such as heroin it is also common to advise:

  • A blood test, which includes testing for HIV, checking the health of your liver (liver function tests) and checking for hepatitis A, B and C.
  • Immunisation against hepatitis A and hepatitis B.
  • If appropriate, immunisation against hepatitis B for your partner and children.

You will also be advised about the dangers of injecting and using shared needles and syringes, and will learn how to reduce your risk of harm.

Taking substitute medication

Methadone is usually prescribed as a once-daily dose in liquid form, Espranor is a wafer which is dissolved on the tongue. You will usually be asked to take it under the supervision of the pharmacist who dispenses the substitute medication to you. This means there can be no doubt about how much medication you take at each dose. Supervision arrangements will be reviewed with your community drug team.

Other Points to Consider

  • You are more likely to succeed in staying off heroin if you have support and counseling from a local drug community team or from self-help groups or other agencies.
  • Please tell the doctor who prescribes your substitute medication about any other prescribed medicines you take, as some can interfere with methadone or espranor, e.g. medicines for epilepsy, TB and some anti-depressants.
  • Other street drugs, such as benzodiazepines (‘benzos’) and alcohol, can affect substitute: it is better not to take any other drugs or drink too much alcohol with either methadone or espranor.
  • You will be asked to give a urine sample from time to time as part of your treatment.
  • If you use heroin, methadone, espranor or similar drugs you should tell the DVLA. You are likely to be suspended from driving. However, if you are on a supervised substitute medication programme, you may be allowed to drive, subject to an annual medical review.
  • Keep methadone, espranor and any other drugs out of reach of children. We can provide you with a locked box.

What is Heroin Dependence?

If you are addicted to heroin it means that you develop withdrawal symptoms within a day or so of the last dose. So, if you are addicted to heroin, you need a regular dose to feel ‘normal’.

Withdrawal symptoms can include: sweating; feeling hot and cold; runny eyes and nose; yawning; being off food; stomach cramps; feeling sick or vomiting; diarrhoea; tremor; poor sleep; restlessness; general aches and pains; and just feeling awful. Withdrawal symptoms tend to ease and go within five days.

However, you may then have a persistent craving for heroin, remain tired, and have poor sleep for quite some time afterwards.

For more information contact CGL Gloucestershire on 01452 223 014