Heroin or conventional opioid maintenance? The patients' perspective

TY - JOUR

T1 - Heroin or conventional opioid maintenance? The patients' perspective

AU - Bald, Lena Karoline

AU - Bermpohl, Felix

AU - Heinz, Andreas

AU - Gallinat, Jürgen

AU - Gutwinski, Stefan

PY - 2013

Y1 - 2013

N2 - OBJECTIVE: This study focused on the question whether patients with conventional opioid maintenance treatment (COMT) would prefer a switch to heroin maintenance treatment (HMT).METHODS: We performed a region-wide anonymous survey of patients in the opioid maintenance program in Berlin, Germany. All 20 psychiatric hospitals and all 110 physicians' practices in Berlin licensed to offer COMT were approached to reach patients under COMT and also fulfilling the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria of opiate dependence. The anonymous questionnaire focused on the question whether patients would prefer HMT to COMT. In our study, 986 of 5032 patients (19.6%) with COMT in Berlin participated. Of them, 881 (89.4%) patients gave information whether they would prefer HMT to COMT.RESULTS: Of the participating patients, 40.9% would prefer HMT to COMT. These patients report more detoxification therapies (P < 0.001), a higher dose of methadone equivalent (P = 0.001), and more often continued use of multiple illegal drugs despite COMT (P < 0.001) than patients not preferring HMT. They also report less improvement in mental health (P < 0.001) and working abilities (P < 0.001) because of COMT than patients not preferring HMT.CONCLUSIONS: The data on the patients' perspective complement the existing clinical studies, showing that previously unresponsive opioid-addicted patients especially would switch to HMT, whereas most patients would prefer continuation of COMT.

AB - OBJECTIVE: This study focused on the question whether patients with conventional opioid maintenance treatment (COMT) would prefer a switch to heroin maintenance treatment (HMT).METHODS: We performed a region-wide anonymous survey of patients in the opioid maintenance program in Berlin, Germany. All 20 psychiatric hospitals and all 110 physicians' practices in Berlin licensed to offer COMT were approached to reach patients under COMT and also fulfilling the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria of opiate dependence. The anonymous questionnaire focused on the question whether patients would prefer HMT to COMT. In our study, 986 of 5032 patients (19.6%) with COMT in Berlin participated. Of them, 881 (89.4%) patients gave information whether they would prefer HMT to COMT.RESULTS: Of the participating patients, 40.9% would prefer HMT to COMT. These patients report more detoxification therapies (P < 0.001), a higher dose of methadone equivalent (P = 0.001), and more often continued use of multiple illegal drugs despite COMT (P < 0.001) than patients not preferring HMT. They also report less improvement in mental health (P < 0.001) and working abilities (P < 0.001) because of COMT than patients not preferring HMT.CONCLUSIONS: The data on the patients' perspective complement the existing clinical studies, showing that previously unresponsive opioid-addicted patients especially would switch to HMT, whereas most patients would prefer continuation of COMT.

KW - Adult

KW - Aged

KW - Analgesics, Opioid

KW - Diagnostic and Statistical Manual of Mental Disorders

KW - Dose-Response Relationship, Drug

KW - Female

KW - Germany

KW - Heroin

KW - Humans

KW - Male

KW - Mental Health

KW - Methadone

KW - Middle Aged

KW - Opiate Substitution Treatment

KW - Opioid-Related Disorders

KW - Patient Outcome Assessment

KW - Patient Preference

KW - Questionnaires

KW - Substance Withdrawal Syndrome

KW - Therapeutic Equivalency

U2 - 10.1097/ADM.0b013e3182a11ad0

DO - 10.1097/ADM.0b013e3182a11ad0

M3 - SCORING: Journal article

C2 - 24145159

VL - 7

SP - 401

EP - 404

JO - J ADDICT MED

JF - J ADDICT MED

SN - 1932-0620

IS - 6

ER -