Take-home dosages in maintenance treatment are of great therapeutic importance, but they include the risk of the substitute being distributed illegally. We reviewed the extent of consumption of illegally acquired medical opiates by 142 opiate- or poly-addicted patients consecutively admitted to a detoxification ward. 76 (53.5%) of them admitted to taking illegally acquired medical opiates, usually methadone, at least once. The cumulative duration was 30 days (median). Motivation was usually due to difficulties in acquiring heroin, however one third reported use in an attempt at self-detoxification or as transition before entering maintenance treatment. Maintenance patients were usually the source of the opiates. The results prove the necessity of stringent conditions for take-home dosages, and illustrate deficits in the health care system.
Ziel: Bewertung der Methadonsubstitution durch Opiatabhängige. </P><P> Methode und Stichprobe: Untersuchung mittels eines selbst entwickelten Fragebogens in zwei Erhebungen von 73 bzw. 101 langjährig substituierten Patienten. </P><P> Ergebnisse: Die Patienten bewerteten im Globalurteil ihre Situation als im Verlauf der Substitution deutlich verbessert. Dies betraf v. a. basale Therapieziele wie Wegfall des Beschaffungsdrucks, Minderung krimineller Aktivitäten und Lösung von der Drogenszene. Bei retrospektiver Erfassung war das Erreichen dieser basalen Therapieziele die wichtigste Erwartung bei Beginn der Substitutionsbehandlung.</P><P> Schlussfolgerung: Die Mehrheit langjährig substituierter Patienten war mit dem Erreichen basaler Ziele zufrieden. Das Erreichen weiterer Ziele bis hin zur Abstinenz setzt bei individueller Indikation zusätzliche motivationale Therapieangebote voraus.
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