Changing substitution treatment for opioid-dependent patients in Germany: therapeutic concepts, legal conditions and substitutes to be used

Research problem: Treating opiate-addicted patients by means of substitute-medicines, in Germany two methods compete with each other: The substitution by means of methadone, which is the recognized method, and the substitution by means of codeins, which is the (still) not recognized method. According to each method about 30.000 opiate addicts are treated. Both methods of treatment differ not only by the kind of medicine used, but also it is evident, that different basic therapeutical concepts are linked with them. Substitution by means of codeins is not subject to any externally imposed rules. This method in respect to physicians and patients as well is characterized by "laisser faire". In contrast, substitution by means of methadone is controlled by law and decrees. This method in respect to patients and physicians is characterized by several elements of commitment and compulsion. Objective: We investigated, to what extent physicians with an entitlement for giving methadone maintenance, are committed to the named therapeutical concepts. Methodology: Data were collected in an anonymous survey of the totality of physicians with an entitlement to carry out methadone maintenance in six regions of Western Germany. As standardized questionnaire was used. The return was 74,8%. Data of 937 physicians could be gave substitution treatment to 13.067 patients altogether at the time of the survey. Results: 30% of physicians used both methods of substitution in treating addicted patients got codeins as patients at the same time 25% of the total of substituted patients got codeins as substitutes The extent to wick patients got the recommended psychosocial care measures as supplement to the medicinal treatment is not dependent by method of substitution used, but the attitude of the physician giving the treatment. (Author' s abstract)