Summary
Substitution treatment (replacement therapy) is the most widespread and the most frequently researched therapeutic approach to heroin dependence. At present, the “gold standard” is methadone maintenance, but the use of other agonists and of combined compounds with antagonists are increasingly used, especially Buprenorphine. This paper reviews the main findings from research and their consequences for best practice rules. The evolution and organisation of substitution treatment in Europe is described, indicating a major discrepancy in administrative regulations. Emerging trends are also mentioned, as well as the merits and limitations that mark the place of substitution treatment in a comprehensive therapeutic network for opioid dependence.
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References
Arif A, Westermeyer J (1990) Methadone maintenance in the management of opioid dependence. An international review. Praeger, New York
Ali R, Auriacombe M, Casas M, Cottier L, Farrell M, Kleiber D, Kreuzer A, Ogborne A, Rehm J, Ward P (1998) Report of the external panel on the evaluation of the Swiss scientific studies of medically prescribed narcotics to drug addicts. Report to World Health Organisation, Geneva
Amass L, Kamien JB, Mikulich SK (2000) Efficacy of daily and alternate-day dosing regimens with the combination buprenorphine-naloxone tablet. Drug Alcohol Depend 58: 143–152
Amass L, Kamien JB, Mikulich SK (2001) Thrice-weekly supervised dosing with the combination buprenorphine-naloxone tablet is preferred to daily supervised dosing by opiate-dependent humans. Drug Alcohol Depend 61: 173–181
Ball JC, Ross A (1991) The effectiveness of methadone maintenance treatment. Springer, New York
Bammer G, Dobler-Mikola A, Fleming PH, Strang J, Uchtenhagen A (1999) The heroin prescribing debate: integrating science and politics. Science 284: 1277–1278
Bertschy G (1995) Pratique des traitements à 1a méthadone, Masson, Paris
Best D, Harris J, Gossop M, Farrell M, Finch E, Noble A, Strang J (2000) Use of non-prescribed methadone and other illicit drugs during methadone maintenance treatment. Drug Alcohol Rev 19: 9–16
Brussel G van (1995) Le programme de distribution de morphine a Amsterdam: experiences pratiques. In: Rihs-Middel M, Clerc J, Stamm R (eds) La préscription de stupéfiants sous contrôle médical. Editions Médecine et Hygiène, Genève, pp 161–167
Bühringer G, Gastpar M, Heinz W, Kovar KA, Ladewig D, Naber D, Täschner KL, Uchtenhagen A, Wanke K (1995) Methadon-Standards. Vorschläge zur Qualitätssicherung bei der Methadonsubstitutionim Rahmen der Behandlung von Drogenabhängigen. Enke, Stuttgart
Calsyn DS, Wells EA, Saxon AJ, Jackson TR, Wrede AF, Stanton V, Fleming C (1994) Contingency management of urinalysis results and intensity of counseling services have an interactive impact on methadone maintenance treatment outcome. J Addict Dis 13: 47–63
Caplehorn JR (1994) A comparison of abstinence-oriented and indefinite methadone maintenance treatment. Int J Addict 29: 1361–1375
Chadderton A (2000) Clinical issues in using buprenorphine in the treatment of opiate dependence. Drug Alc Rev 19: 329–335
Chutuape MA, Silverman K, Stitzer ML (1998) Survey assessment of methadone treatment services as reinforcers. Am J Drug Alcohol Abuse 24: 1–16
Cooper JR, Altman F, Brown BS, Czechowicz D (1983) Research on the treatment of narcotic addiction. The state of the art. National Institute on Drug Abuse, Rockville
Dees SM, Dansereau DF, Simpson DD (1997) Mapping-enhanced drug abuse counseling: urinalysis results in the first year of methadone treatment. J Subst Abuse Treat 14: 45–54
Dolan K, Hall W, Wodak A (1998) The provision of methadone within prison settings. In: Ward J, Mattick RP, Hall W (eds) Methadone maintenance treatment and other opioid replacement therapies. Harwood, Amsterdam, pp 379–396
Dole V, Nyswander M (1965) A medical treatment for Diacetylmorphine (heroin) addiction. JAMA 193: 146–150
Elkashef A (2002) Medications for the treatment of opiate dependence in the US. Current therapies and new developments. Communication in WHO Meeting, April 2002
EMCDDA (2000) Reviewing current practice in drug-substitution treatment in the European Union. European Monitoring Centre for Drugs and Drug Addiction EMCDDA, Lisbon
EMEA (2001) Public statement on the recommendation to suspend the marketing authorisation for Orlaam in the European Union. European Agency for the Evaluation of Medicinal Products, London
Finnegan LP, Hagan T, Kaltenbach KA (1991) Scientific foundation of clinical practice: opiate use in pregnant women. Bull NY Acad Med 67: 223–239
Fudala PJ, Yu E, Macfadden W, Boardman C, Ciang CN (1998) Effects of buprenorphine and naloxone in morphine-stabilised opioid addicts. Drug Alcohol Depend 50: 1–8
Gossop M (1998) NTORS at one year. The National Treatment Outcome Research Study. Department of Health, London
Hartnoll R, Mitcheson M, Battersby A, Brown G, Ellis M, Fleming P, Hedley N (1980) Evaluation of heroin maintenance in a controlled trial. Arch Gen Psychiatry 37: 877–884
Hubbard RL, Marsden ME, Rachal JV, Haarwood HJ, Cavanaugh ER, Ginzburg HM (1989) Drug abuse treatment. A national study of effectiveness. University of North Carolina Press, Chapel Hill
Kreek MJ (1996) Long-term pharmacotherapy for opiate (primarily heroin) addiction: opioid agonists. In: Schuster CH, Kuhar MJ (eds) Pharmacological aspects of drug dependence. Toward an integrated neurobehavioral approach. Springer, Berlin Heidelberg New York Tokyo, pp 487–562
Lifschitz MH, Wilson GS, Smith EO, Desmond MM (1985) Factors affecting head growth and intellectual function in children of drug addicts. Pediatrics 75: 269–274
Ling W, Klett JC, Gillis RC (1980) A cooperative clinical study of methadyl acetate. Arch Gen Psychiatry 37: 908–911
McLellan AT, Arndt IO, Metzger IS, Woody GE, O’Brien CP (1993) The effects of psychosocial services in substance abuse treatment. JAMA 269:1953–1959
Maddux JF, Desmond DP, Esquivel M (1995) Rapid admission and retention on methadone. Am J Drug Alcohol Abuse 21: 533–547
Mattick RP, Oliphant D, Ward J, Hall W (1998) The effectiveness of other opioid replacement therapies: LAAM, Heroin, Buprenorphine, Naltrexone and injectable maintenance. In: Ward J, Mattick RP, Hall W (eds) Methadone maintenance treatment and other opioid replacement therapies. Harwood, Amsterdam, pp 123–160
Mendelson J, Jones RT, Welm S, Baggott M, Fernandez I, Melby AK, Nath RP (1999) Buprenorphine and naloxone combinations: the effects of three dose ratios in morphine-stabilised, opiate dependent volunteers. Psychopharmacology 141: 37–46
Metrebian N, Shanahan W, Wells B, Stimson GV (1998) Feasibility of prescribing injectable heroin and methadone to opiate-dependent drug users: associated health gains and harm reductions. Med J Aust 168: 596–600
Mino A (1990) Analyse scientifique de la litérature sur la remise contrôlée d’héroïne ou de morphine. Institutions universitaires de psychiatrie, Genève
National Institute of Drug Abuse NIDA (1999) Principles of drug addiction treatment. A research-based guide. National Institute of Drug Abuse, National Institutes of Health, Bethesda, MD
National Institutes of Health NIH (1998) National consensus development panel on effective medical treatment of opiate addiction. JAMA 280: 1936–1943
Parrino MW (1991) State Methadone Treatment Guidelines. U.S. Department of Health and Human Services, Rockville
Raschke P (1994) Substitutionstherapie. Ergebnisse langfristiger Behandlung von Opiatabhängigen. Lambertus, Freiburg im Breisgau
Rhee JM van (1998) Study on the effectiveness of medically coprescribed heroin. Progress report. Central Committee on the Treatment of Heroin Addicts, Utrecht
Rhoades HM, Creson D, Elk R, Schmitz J, Grabowsk J (1998) Retention, HIV risk, and illicit drug use during treatment: methadone dose and visit frequency. Am J Publ Health 88: 34–39
Robinson GM, Dukes PD, Robinson BJ, Cook RR, Mahoney GN (1993) The misuse of buprenorphine and buprenorphine-naloxone combination in Wellington, New Zealand. Drug Alcohol Depend 33: 81–86
Ruel JM (1996) International survey on the use of methadone in the treatment of narcotic addiction. Bureau of Drug Surveillance, Ottawa, Canada
Savage C, Karp EG, Curran SF, Hanlon TE, McCabe OL (1976) Methadone/LAAM maintenance: a comparison study. Compr Psychiatry 17: 415–424
Scott RTA, Jay MJH, Keith R, Oliver JS, Cassidy MT (1999) A confidential enquiry into methadone-related deaths. Addiction 94: 1789–1794
Seidenberg A, Honegger U (1998) Methadon, Heroin und andere Opioide. Medizinisches Manual für die ambulante opioidgestützte Behandlung. Huber, Bern
Senay EC, Uchtenhagen A (1990) Methadone in the treatment of opioid dependence. In: Arif A, Westermeyer J (eds) Methadone maintenance in the management of opioid dependence. Praeger, New York, pp 19–54
Senay EC, Barthwell A, Marks R, Bokos PJ (1994) Medical maintenance: an interim report. J Addict Dis 13: 65–69
Simpson DD, Sells SB (1990) Opioid addiction and treatment: a 12-year follow-up. Krieger, Malabar
Simpson DD, Curry SJ (eds) (1997) Drug Abuse Treatment Outcome Study DATOS. Psychol Addict Behav 11 (special issue)
Simpson DD, Joe GW, Dansereau DF, Chatham LR (1997) Strategies for improving methadone treatment process and outcomes. J Drug Issues 27: 239–260
Stitzer ML, Iguchi MY, Felch LJ (1992) Contingent take-home incentive: effects on drug use of methadone. J Consult Clin Psychol 60: 927–934
Strang J, Gossop M (1996) Heroin prescribing in the British system: a historical review. Eur Addict Res 2: 185–193
Svikis DS, Lee JH, Haug NA, Stitzer ML (1997) Attendance incentives for outpatient treatment: effects in methadone-and nonmethadone-maintained pregnant drug dependent women. Drug Alcohol Depend 48: 33–41
Tennant FS, Rawson RA, Pumphrey E, Seecof R (1986) Clinical experiences with 959 opioid-dependent patients treated with levo-alpha-acetylmethadol (LAAM). J Subst Abuse Treatment 3: 195–202
Uchtenhagen A, Zimmer-Höfler D (1985) Heroinabhängige und ihre normalen Altersgenossen. Herkunft, Lebenssituation, Zweijahresverlauf im Quervergleich. Haupt, Bern
Uchtenhagen A, Dobler-Mikola A, Steffen T, Gutzwiller F, Blättler R, Pfeifer S (1999) Prescription of narcotics for heroin addicts. Main results of the Swiss National Cohort Study. Karger, Basel
Van den Brink W, Hendriks VM, Blanken P, Huijsman JA, van Ree JM (2002) Medical co-prescription of heroin. Two randomised controlled trials. Central Committee on the Treatment of Heroin Addicts, Utrecht
Verthein U, Degkwitz P, Haasen C, Raschke P, Krausz M (1996) Die Substitutionsbehandlung Opiatabhängiger mit Codein/Dihydrocodein und Methadon — ein Kontrollgruppenvergleich. Sucht 42: 108–115
Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE (1994) Clinical pharmacology of buprenorphine. Ceiling effects at high doses. Clin Pharmacol Ther 55: 569–580
Ward J, Mattick R, Hall W (1998) Methadone maintenance treatment and other opioid replacement therapies. Harwood, Amsterdam
Westermann B, Bellmann G, Jellinek C (eds) (2000) Beigebrauch: offene Grenzen der Substitution. Beltz, Weinheim
Woody GE, McLellan AT, Luborsky LO, Brien CP Psychotherapy in community methadone programs: a validation study. Am J Psychiatry 152: 1302–1308
World Health Organization (1989) Options for the use of methadone in the treatment of drug dependence. Geneva (WHO/MNH/DAT/89/2)
World Health Organisation (1998) WHO Expert Committee on Drug Dependence. Thirtieth Report. WHO, Geneva (Technical Report Series 873)
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Uchtenhagen, A. (2003). Substitution management in opioid dependence. In: Fleischhacker, W.W., Brooks, D.J. (eds) Addiction Mechanisms, Phenomenology and Treatment. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0541-2_3
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DOI: https://doi.org/10.1007/978-3-7091-0541-2_3
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