[Opioid Substitution Treatment in Germany: Physicians' View on the Effects of the 3rd Revision of the Narcotic Drugs Prescription Ordinance].

Autor:	Lehmann K; Universitätsklinikum Hamburg-Eppendorf, Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Hamburg, Deutschland., Kuhn S; Universitätsklinikum Hamburg-Eppendorf, Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Hamburg, Deutschland., Schulte B; Universitätsklinikum Hamburg-Eppendorf, Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Hamburg, Deutschland., Meyer-Thompson HG; Substitutionsambulanz Altona, Asklepios Klinik Nord - Ochsenzoll, Klinik für Abhängigkeitserkrankungen, Hamburg, Deutschland., Verthein U; Universitätsklinikum Hamburg-Eppendorf, Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Hamburg, Deutschland.
Jazyk:	němčina
Zdroj:	Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) [Gesundheitswesen] 2021 Sep; Vol. 83 (8-09), pp. 651-661. Date of Electronic Publication: 2021 Mar 01.
DOI:	10.1055/a-1378-9249
Abstrakt:	Study Aim: Opioid substitution treatment (OST) is the most effective drug treatment for opioid dependence worldwide. This form of therapy is also well established in Germany. Nevertheless, there are gaps in the provision of care, especially in rural areas and some states, due to a decreasing number of physicians involved in implementing the substitution programs. The 3 rd revision of the Narcotic Drugs Prescription Ordinance (NDPO), which came into force in 2017, transferred medical therapeutic tasks of OST to the policy-making power of the German Medical Association. This comprehensive reform of the general conditions for OST led to greater legal certainty for this form of treatment. The present study aimed to analyze the effects of the 3 rd revision of the Narcotic Drugs Prescription Ordinance from the providers' perspective. Methods: Between August and December 2019, a questionnaire on individual experiences with the changes implemented in 3 rd revision of the Narcotic Drugs Prescription Ordinance was sent by the Federal Opium Agency and the Associations of Statutory Health Insurance Physicians of the chosen federal states to 2,503 physicians implementing the substitution program in Germany as well as 563 physicians in Hamburg, Bavaria, North Rhine-Westphalia and Saxony who were not or no longer involved in this field of medical practice.The evaluation distinguished between physicians with and without further training in addiction medicine and between urban and rural districts. Results: The response rate of physicians was 34.1%. The average age was 57.9 (±8.7) years, and 64.5% were male. The most relevant changes of the NDPO revision were found to be no time limit for achieving opioid abstinence (85.3%), new assessment and treatment using additional psychotropic substances (71.0%), extending take-home regulation to a maximum of 30 days (70.0%) and greater legal certainty (66.2%). Widening of consultative care up to 10 patients met with little approval (14.8%); 36.7% did not believe that care of substituted patients was assured either now or in the future. Conclusions: The NDPO revisions were considered to be relevant in terms of increased legal certainty and treatment liberties. Information was needed in rural areas, among physicians who carried out substitution therapy without advanced training in addiction medicine and physicians no longer involved in substitution therapy. Competing Interests: KL erhielt eine Reisekostenerstattung sowie eine Kostenübernahme von Teilnahmegebühren und Übernachtungskosten von pcm scientific sowie die Übernahme von Konferenzteilnahmegebühren von Sanofi-Aventis. SK hat keine Interessenkonflikte. BS hat von CAMURUS Fördermittel sowie Reisekosten erhalten. H-GM-T ist Redakteur des Internetforums Substitutionspraxis. Er erhält dafür von den auf der Homepage ausgewiesenen Firmen keine Zuwendungen. UV erhielt innerhalb der letzten 3 Jahre Vortrags-, Beratungshonorar und Reisekostenerstattungen von Mundipharma GmbH sowie finanzielle Projektförderung und Reisekostenerstattungen von CAMURUS GmbH. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
Databáze:	MEDLINE
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