Anja Dobler-Mikola

Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study

BACKGROUND Heroin-assisted substitution treatment for severely opioid-dependent drug users has been available in Switzerland since 1994. Our aim was to ascertain the feasibility, safety, and efficacy of this treatment. METHODS We did a cohort study in 21 community outpatient treatment centres. We assessed 1969 opioid-dependent drug users, who began heroin-assisted substitution treatment between January, 1994, and December, 2000, to ascertain admission and discharge patterns, and patient characteristics. We also followed up a subset of 237 patients who began treatment between Jan 1, 1994, and March 31, 1995, and who stayed with the programme for at least 18 months. We used questionnaires, interviews, and medical examinations done at entry and after 6, 12, and 18 months to assess somatic and mental health, social integration, and treatment outcomes. FINDINGS More than 70% (1378) of patients remained in treatment for more than a year. Treatment showed positive effects with respect to health and social outcomes. A long stay in treatment was related to a higher chance of starting abstinence-oriented therapy than a short stay. INTERPRETATION Heroin-assisted substitution treatment might be an effective option for chronically addicted patients for whom other treatments have failed.

Programme for a Medical Prescription of Narcotics

The national study on medically controlled prescription of narcotics (heroin, morphine and intravenous methadone) was evaluated and a report on the main findings is made available, based on the main study and a number of additional special studies. The study with an intention-to-treat design includes data on 1035 probands. They received treatment following a uniform study protocol in 17 out-patient clinics and 1 penitentiary. The attribution of substances varied however (2 double-blind studies, 3 randomisation studies, the rest followed an individual indication). Intravenous heroin was well accepted and superior to intravenous morphine and methadone concerning compliance (reduction of illegal drug use) and retention, due to less negative side-effects. Dosages were stabilised, no lethal overdose occurred. The study documented significant improvement in health and social status of participants, especially in a reduction of depressive and anxiety states, of contacts with the drug scene and of illegal activities and prostitution. Half of those who left treatment proceeded to detoxification or methadone maintenance. Mortality, to a large extent due to infectious diseases acquired before participation in the study was by 1 % of the cohort per year. A continuation of this treatment approach is recommended for chronic and marginalised heroin addicts who failed in other treatment modalities. Similar conditions and safety controls as established for the study should be applied.

Die heroingestützte Behandlung von Opiatabhängigen Erfahrungen aus den Schweizerischen Versuchen für eine ärztliche Verschreibung von Betäubungsmitteln (PROVE)

Zum ThemaDieser Studienbericht über die heroingestütze Behandlung von Opiatabhängigen ergänzt den anderen Artikel im gleichen Heft, in dem über die Methadon-Substitution referiert wird (vgl. die Arbeit von M. Krausz et al.). Bemerkenswert ist, daß die Verschreibung von injizierbarem Heroin der von injizierbarem Morphin und Methadon hinsichtlich der Rekrutierbarkeit, Verweildauer in Behandlung und Compliance überlegen ist. Als positiv ist auch die geringere Nebenwirkungsrate bei Heroin-Substitution einzustufen.Im einzelnen wird sodann über den somatischen Zustand der Abhängigen, den Konsum von illegalem Heroin und Kokain, die soziale Integration, Delinquenz, Haltequote und Sterberate referiert. Zu den wesentlichen Daten der Hauptstudie, die Thema dieser Arbeit ist, seien Interessierte besonders auf die begleitenden medizinischen, sozial- und wirtschaftswissenschaftlichen Studien verwiesen, die im Text erwähnt und im Literaturverzeichnis aufgeführt sind.

Gesundheitsökonomische Bewertung der Versuche für eine ärztliche Verschreibung von Betäubungsmitteln (PROVE)

In the 1994-1996 trial of medically controlled prescription of narcotics to dependent users, 800 places were ascribed to heroin substitutes and another 200 for methadone and morphine substitutes. The trial was evaluated with the aid of an accompanying research. Among the results demonstrated in the evaluation was an improvement of the health of the participants. The economic assessment was drawn from observations of health effects within a sub-sample of 142 participants from four centers. In a retrospective statistical survey, for each acute illness which could be influenced through the trial, the number of diagnoses was recorded in the first and thirteenth month after study entry. Also, based on a number of representative cases for each of these acute illnesses, the resource use, i.e. the types and numbers of medical products and services rendered to the patients, was recorded. The results showed a clear decline in depressive episodes, skin diseases, digestive system disorders as well as epileptic attacks and intoxication. Treatment costs could be reduced from a total of CHF 94875.--to CHF 21,998.--/month or from CHF 22.27 to CHF 5.15/patient per day. The improvement of somatic and psychic health due to the medically controlled prescription of narcotics resulted in a benefit of CHF 17.11/person per day.

Economic evaluation in a trial of medically controlled prescription of narcotics to dependent users (PROVE)

In the 1994-1996 trial of medically controlled prescription of narcotics to dependent users, 800 places were ascribed to heroin substitutes and another 200 for methadone and morphine substitutes. The trial was evaluated with the aid of an accompanying research. Among the results demonstrated in the evaluation was an improvement of the health of the participants. The economic assessment was drawn from observations of health effects within a sub-sample of 142 participants from four centers. In a retrospective statistical survey, for each acute illness which could be influenced through the trial, the number of diagnoses was recorded in the first and thirteenth month after study entry. Also, based on a number of representative cases for each of these acute illnesses, the resource use, i.e. the types and numbers of medical products and services rendered to the patients, was recorded. The results showed a clear decline in depressive episodes, skin diseases, digestive system disorders as well as epileptic attacks and intoxication. Treatment costs could be reduced from a total of CHF 94875.--to CHF 21,998.--/month or from CHF 22.27 to CHF 5.15/patient per day. The improvement of somatic and psychic health due to the medically controlled prescription of narcotics resulted in a benefit of CHF 17.11/person per day.

Gesundheitskonomische Bewertung der Versuche fr eine rztliche Verschreibung von Betubungsmitteln (PROVE)@@@Economic evaluation in a trial of medically controlled presciption of narcotics to dependent users (PROVE)@@@Evaluation socio-conomique due project de prescription mdicale de stupfiants (PROVE)

In the 1994-1996 trial of medically controlled prescription of narcotics to dependent users, 800 places were ascribed to heroin substitutes and another 200 for methadone and morphine substitutes. The trial was evaluated with the aid of an accompanying research. Among the results demonstrated in the evaluation was an improvement of the health of the participants. The economic assessment was drawn from observations of health effects within a sub-sample of 142 participants from four centers. In a retrospective statistical survey, for each acute illness which could be influenced through the trial, the number of diagnoses was recorded in the first and thirteenth month after study entry. Also, based on a number of representative cases for each of these acute illnesses, the resource use, i.e. the types and numbers of medical products and services rendered to the patients, was recorded. The results showed a clear decline in depressive episodes, skin diseases, digestive system disorders as well as epileptic attacks and intoxication. Treatment costs could be reduced from a total of CHF 94875.--to CHF 21,998.--/month or from CHF 22.27 to CHF 5.15/patient per day. The improvement of somatic and psychic health due to the medically controlled prescription of narcotics resulted in a benefit of CHF 17.11/person per day.