Richard Blättler

INFECTIOUS DISEASES AND PUBLIC HEALTH: RISK-TAKING BEHAVIOR DURING PARTICIPATION IN THE SWISS PROGRAM FOR A MEDICAL PRESCRIPTION OF NARCOTICS (PROVE)

The medically controlled prescription of narcotics program (PROVE) followed a uniform protocol from January 1, 1994 until December 31, 1996. The program included 800 slots for heroin prescription, 200 slots for intravenous methadone prescription, and 200 slots for intraveneous morphine. Admission criteria were age 20 and above, minimum 2-year duration of daily heroin consumption, failure in at least two previous treatments, and documented social and/or health deficits. There was a very high seroprevalence of hepatitis B (73%) and hepatitis C (82%) among the 1035 entrants. The rate of HIV (15%) was also high compared with prevalence of infection in other therapy programs (methadone program, inpatient therapy). The prevalence of HIV and hepatitis B/C increased with the duration of drug dependence and cocaine use. During treatment, use of street heroin and cocaine could be reduced substantially. After 18 months of continued participation in the program, 74% of patients reported no illegal heroin consumption, and the rate of cocaine abstinence increased from 15% at entry to 41%. Significant declines in visits to the drug scene, illegal income, and needle sharing were also observed. The high prevalence of HIV and hepatitis B and C confirm that a group of drug dependence with severe medical problems was reached in accordance with the admission criteria for the studies. During treatment, a significant reduction in risk-taking behavior was observed in a target population of heroin-dependent persons who failed in previous treatments. [Translations are provided in the International Abstracts Section of this issue.]

Dosage regimes in the prescription of heroin and other narcotics to chronic opioid addicts in Switzerland--Swiss national cohort study.

Aims: Within the guidelines of the research programme on medical prescription of narcotics for opioid addicts (PROVE), heroin, morphine, and methadone were prescribed to heavily opioid addicted individuals in Switzerland since 1994. This contribution analyses the course of dose levels during the treatment period. Design: Naturalistic description of consumed dosages per day and month. Setting and Participants: The study describes the dosages prescribed to all individuals who began outpatient treatment in the PROVE programme in Switzerland between 1994 and 1996. Measurements: Consumed amount of narcotics per day and the course of dosage of injectable heroin in different treatment regimes. Findings: Heroin was the most frequently prescribed narcotic. Of all consumption days, heroin had been applied in 77% as injection and in 9% in a smokeable form. The mean daily dosage was 474 mg for intravenous application and 993 mg for the smokeable form. Second most frequent was the prescription of oral methadone, in most cases in combination with heroin. The mean amount of daily consumption of oral methadone was 53 mg. There were dosage differences between treatment regimes. During the course of treatment the mean dosage for injectable heroin per day decreased significantly and, depending on the treatment regime, almost linearly. Conclusions: The significance of heroin dosages in heroin-assisted therapy for treatment outcome should be further explored, especially in the light of the markedly higher dosages in Switzerland compared to the UK. During the treatment period, dosages did not increase but generally decreased, indicating no further increase in tolerance.

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.

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.