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Abstract

BackgroundAfter a long and controversial debate methadone maintenance treatment (MMT) was first introduced in Germany in 1987. The number of patients in MMT – first low because of strict admission criteria – increased considerably since the 1990s up to some 65,000 at the end of 2006. In Germany each general practitioner (GP), who has completed an additional training in addiction medicine, is allowed to prescribe substitution drugs to opioid dependent patients. Currently 2,700 GPs prescribe substitution drugs. Psychosocial care should be made available to all MMT patients.ResultsThe results of research studies and practical experiences clearly indicate that patients benefit substantially from MMT with improvements in physical and psychological health. MMT proves successful in attaining high retention rates (65 % to 85 % in the first years, up to 50 % after more than seven years) and plays a major role in accessing and maintaining ongoing medical treatment for HIV and hepatitis. MMT is also seen as a vital factor in the process of social re-integration and it contributes to the reduction of drug related harms such as mortality and morbidity and to the prevention of infectious diseases. Some 10 % of MMT patients become drug-free in the long run. Methadone is the most commonly prescribed substitution medication in Germany, although buprenorphine is attaining rising importance. Access to MMT in rural areas is very patchy and still constitutes a problem. There are only few employment opportunities for patients participating in MMT, although regular employment is considered unanimously as a positive factor of treatment success. Substitution treatment in German prisons is heterogeneous in access and treatment modalities. Access is very patchy and the number of inmates in treatment is limited. Nevertheless, substitution treatment plays a substantial part in the health care system provided to drug users in Germany.ConclusionIn Germany, a history of substitution treatment spanning 20 years has meanwhile accumulated a wealth of experience, e.g. in the development of research on health care services, guidelines and the implementation of quality assurance measures. Implementing substitution treatment with concomitant effects and treatment elements such as drug history-taking, dosage setting, co-use of other psychoactive substances (alcohol, benzodiazepines, cocaine), management of 'difficult patient populations', and integration into the social environment has been arranged successfully. Also psychosocial counseling programmes adjuvant to substitution treatment have been established and, in the framework of a pilot project on heroin-based treatment, standardised manuals were developed. Research on allocating opioid users to the 'right' form of therapy at the 'right' point in time is still a challenge, though the pilot project 'heroin-based treatment' brought experience with patients who do not benefit from methadone treatment. There is also expertise in the treatment of specific co-morbidity such as HIV/AIDS, hepatitis and psy...

Drug use and opioid substitution treatment for prisoners

“…In most European countries that offered OST in prison, access to and varieties of available OST programmes were heterogeneous and inconsistent [5,24]. For example, although OST is nominally available in German prisons, implementation is the responsibility of each of the 16 federal states and often varies from prison to prison within states [25]. In France, many physicians have been reluctant to initiate OST in prison or even to renew existing buprenorphine or methadone prescriptions for prisoners [26].…”

“…After 4 months in prison, the rate of illicit use of morphine was 27% for MMT-treated prisoners and 42% for controls ( P = 0.05) [39]. The use of buprenorphine maintenance therapy in prisons has been based chiefly on results obtained outside prisons [23,25]; however, there is growing experience with buprenorphine in prisons [29]. A group of prisoners receiving buprenorphine reported for their designated post-release treatment programme significantly more often than did a comparison group receiving methadone (48% vs. 14%, respectively; P < 0.001) [40].…”

“…This education may include evidence of beneficial results of OST, including reduced rates of drug abuse, both in prison and after release from prison [23,25,35,36,39], less risk-taking behaviour [11,38], reduced rate of infectious disease acquisition [39,42], reduced risk for death [42], decrease in serious violent drug charges [21], reduced criminal activity after release [44] and reduced re-incarceration rate [21,42,45,46]. Outcomes and health economic data demonstrating results of studies showing the cost-effectiveness of drug maintenance therapy in prisons [21,47] should be included.…”

Influence of Peer-Based Needle Exchange Programs on Mental Health Status in People Who Inject Drugs: A Nationwide New Zealand Study

“…Building on existing community networks, trained peers assist PWID to access exchangers, distribute information about safer drug use and safer sex, and facilitate referrals to other user-friendly health services. Although not exempt of limitations and shortcomings (8), the peer service model, in addition to disseminating safer practices and making a variety of health services more accessible, emphasizes the importance of reconstructing relationships with family, friends, and the community at large (9, 10), which may ultimately contribute to promote greater psychological stability and enhance the benefits of psychiatric interventions. In the area of mental health, there is considerable theoretical and experiential support for the notion that peer support may exert a positive influence in multiple relevant domains, including empowerment (11), symptom distress (12), self-esteem (13), and social integration (14).…”

“Bureaucracy & Beliefs”: Assessing the barriers to accessing opioid substitution therapy by people who inject drugs in Ukraine

“…OST is internationally recognized as one of the most effective harm reduction and HIV prevention and treatment strategies for opioid-dependent PWIDs (Altice, Kamarulzaman, Soriano, Schechter, & Friedland, 2010; Dutta et al, 2013; Kerr, Wodak, Elliott, Montaner, & Wood, 2004). It enhances quality-of-life, improves employment and social functioning (De Maeyer, van Nieuwenhuizen, Bongers, Broekaert, & Vanderplasschen, 2013; Korthuis et al, 2011; Nosyk, 2011), and reduces injection-related transmission of HIV and viral hepatitis (Gowing, Farrell, Bornemann, Sullivan, & Ali, 2008), crime, overdoses and health-related co-morbidity (Dennis et al, 2014; Fingleton, Matheson, & Jaffray, 2014; Michels, Stover, & Gerlach, 2007). For HIV-infected patients, it improves ART access, retention in care (Altice et al, 2011; Uhlmann et al, 2010) and adherence (Malta, 2010).…”