Opioid agonist treatment in transition: A cross-country comparison between Austria, Germany and Switzerland

Schwarz, Tanja; Anzenberger, Judith; Busch, Martin; Gmel, Gerhard; Kraus, Ludwig; Krausz, Michael; Labhart, Florian; Meyer, Maximilian; Schaub, Michael P.; Westenberg, Jean N.; Uhl, Alfred

doi:10.1016/j.drugalcdep.2023.111036

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…We feel it is crucial to address this topic to gain knowledge and routine in working with SUD patients in palliative care, as this group will probably increase over the years due to the commendable harm-reduction policy of Switzerland and the substantial rate of SUD patients undergoing opioid agonist therapy [ 22 ]. Indeed, opioid agonist therapies may be associated with reduced, potentially dangerous opioid co-use [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and clinical challenges in patients with substance use disorder in palliative care—experience from a tertiary center in a high-income country

Marti,

Hünerwadel,

Hut

et al. 2024

BMC Palliat Care

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Background Access to palliative care is often limited for challenging and vulnerable groups, including persons with substance use disorders. However, with optimized healthcare options and liberal substitution policies, this patient group is likely to increase over the upcoming years, and comorbidities will also influence the need for palliative support. Here, we aim at analyzing characteristics and specific challenges associated with substance use disorders (SUD) in palliative care. Methods We retrospectively reviewed all patients diagnosed with substance use disorder that were treated at our Competence Center Palliative Care within the University Hospital Zurich, Switzerland between 2015 and 2021. Patient characteristics, including age, gender, duration of hospitalization, as well as specific metrics like body mass index, distinct palliative care assessment scores, and in-hospital opioid consumption were retrieved from the electronic patient files. Demographics and clinical data were analyzed by descriptive statistics, and compared to those of a control group of palliative care patients without SUD. An opioid calculator was used to standardize opioid intake based on morphine equivalents for meaningful comparisons. Results The primary characteristics revealed that the majority of individuals were single (56%), had no children (83%), lived alone (39%), and were either unemployed or recipients of a disability pension (in total 50%). Nicotine (89%), opioids (67%), and alcohol (67%) were the most used substances. We identified various comorbidities including psychiatric illnesses alongside SUD (56%), hepatitis A, B, or C (33%), and HIV infection (17%). Patients with SUD were significantly younger (p < 0.5), predominantly male (p < 0.05), and reported a higher prevalence of pain (p < 0.5) compared to the standard cohort of palliative patients. Regarding the challenges most frequently reported by healthcare practitioners, non-compliance, multimorbidity, challenging communication, biographical trauma, lack of social support, and unstable housing situations played a key role. Conclusion Patients with SUD represent a complex and vulnerable group dealing with multiple comorbidities that profoundly affect both their physical and psychological well-being. Understanding their unique characteristics is pivotal in providing precise and suitable palliative care.

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Section: Discussionmentioning

confidence: 99%

Characteristics and clinical challenges in patients with substance use disorder in palliative care—experience from a tertiary center in a high-income country

Marti,

Hünerwadel,

Hut

et al. 2024

BMC Palliat Care

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“…Cette augmentation est la conséquence de la présence massive des cohortes mentionnées au chapitre précédent. Ce phénomène n'est pas limité à la Suisse, et s'observe également dans d'autres pays européens (Nordt et al, 2018;Schwarz et al, 2023).…”

Section: âGe Moyen Des Personnes En Traitement Depuis 2000unclassified

Statistique nationale des traitements par agonistes opioïdes - Résultats 2022

Labhart,

Amos

2023

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Remerciements : Nous tenons tout particulièrement à remercier les médecins cantonaux et leurs collaborateur•trice•s pour leur engagement et le suivi au quotidien des annonces de traitement dans leurs cantons respectifs. Nous remercions également l'équipe du Prof. Laura Elena Raileanu de la HEIG-VD pour le support et la maintenance du système de saisie des demandes d'autorisation de traitement substitution-online.ch. Nous remercions également chaleureusement Frank Zobel et Rahel Bischof pour la relecture et la traduction de ce rapport.

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Challenges for the implementation of injectable opioid agonist treatment: a scoping review

Schwarz,

Akartuna,

Busch

et al. 2024

Harm Reduct J

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Background and aims Injectable opioid agonist treatment (iOAT) is a valuable, patient-centred, evidence based intervention. However, limited information exists on contextual factors that may support or hinder iOAT implementation and sustainability. This study aims to examine existing research on iOAT using diacetylmorphine and hydromorphone, focusing on identifying the key barriers and facilitators to its successful implementation. Methods A systematic search was conducted in the MEDLINE and PsycInfo databases (via Ovid) from inception to February 2024, supplemented by a comprehensive grey literature search. No restrictions were applied regarding publication type, year, or geographic location. Articles were independently screened by two reviewers. Eligible articles described the feasibility, implementation, and/or evaluation of iOAT in one or more countries, presenting perspectives on receiving, administering, or governing iOAT. Results Forty-four publications were selected for inclusion. Barriers identified through thematic analysis included public acceptance concerns such as medication diversion, increased crime, and the Honey-Pot effect. Legal and ethical challenges identified involved enacting changes in law to make certain substances available as a medically controlled options for treatment, and addressing patient consent issues. Negative media coverage and public controversies were found to undermine acceptance, and high start-up costs especially for security, facility access, and economic feasibility were seen as additional obstacles. Regulatory barriers and stringent protocols were the most frequently cited limiting factors by patients and providers. Facilitators included the integration of trial prescriptions into comprehensive drug policy strategies and publishing data for evidence-based debates, together with ethics committees ensuring compliance with ethical standards. Developing information strategies and addressing opponents’ claims improved public perception. Cost-effectiveness evidence was found to support long-term implementation, while flexible treatment protocols, inclusive spaces, and affirming therapeutic relationships were seen as important facilitators to enhance patient engagement and treatment effectiveness. Conclusions Successful implementation of iOAT requires balancing political and social acceptability with scientific integrity, alongside strategic communication and public outreach. Further research is needed to enhance the transferability of findings across diverse socio-political contexts and address key influencing factors associated with iOAT programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-024-01102-x.

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Opioid agonist treatment in transition: A cross-country comparison between Austria, Germany and Switzerland

Cited by 3 publications

References 40 publications

Characteristics and clinical challenges in patients with substance use disorder in palliative care—experience from a tertiary center in a high-income country

Characteristics and clinical challenges in patients with substance use disorder in palliative care—experience from a tertiary center in a high-income country

Statistique nationale des traitements par agonistes opioïdes - Résultats 2022

Challenges for the implementation of injectable opioid agonist treatment: a scoping review

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