Die Qualität in der Versorgung Opiatabhängiger in substitutionsgestützter Behandlung – Eine Diskussion vor dem Hintergrund der PREMOS-Studie

Hessel, Franz; Pfeiffer-Gerschel, Tim; Reimer, Jens

doi:10.1055/s-0034-1367040

Cited by 1 publication

(1 citation statement)

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“…Contrary, a surprisingly high number of patients was inadequately dosed upon study entry. Abstinence orientation in German opioid substitution regulations may contribute to restrained dosing [16, 26, 27]. However, inadequate methadone doses according to ODAS at baseline did not go along with premature treatment drop-out.…”

Section: Discussionmentioning

confidence: 99%

The opiate dosage adequacy scale for identification of the right methadone dose—a prospective cohort study

Walcher¹,

Koc²,

Reichel³

et al. 2016

BMC Pharmacol Toxicol

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BackgroundOpioid maintenance treatment with methadone is regarded as gold standard in the therapy of opioid dependence. Identification of the ‘right’ methadone dose, however, remains challenging. We wanted to explore if the Opiate Dosage Adequacy Scale (ODAS) is a helpful instrument in methadone titration.MethodsWithin this 12-months prospective naturalistic cohort study patients in stable maintenance treatment with methadone (Eptadone®) were included. Sociodemographic and clinical data were gathered at baseline, and months 3, 6, and 12. At the same points in time, the instruments ODAS, European Addiction Severity Index (EuropASI), and Derogatis Interview for Sexual Functioning-Self Report (DISF-SR) were applied.ResultsFive hundred fifteen patients were enrolled, 129 patients prematurely terminated substitution treatment (treatment failure), in 108 patients substitution medication was changed, likely due to bitter taste of Eptadone®. Complete longitudinal ODAS and EuropASI data sets were available for 229 patients. The frequency of adequate methadone doses (ODAS) increased (60.9 % at baseline, 85.3 % at month 12) as well as the average daily methadone dose (63.8 (±30.8) mg/day at baseline to 69.6 (±36.0) mg/day at month 12). Inadequacy of methadone dose was not associated with treatment failure (RR 1.019; CI 95 % 0.756–1.374). Addiction severity decreased statistically significantly. Compared to adequately dosed patients, inadequately dosed patients benefited more, in that they showed greater improvements in ODAS scores, had higher increases in methadone dose, and partially experienced more advanced sexual functioning.ConclusionApplication of ODAS was associated with improved methadone dose adequacy and addiction severity parameters as well as increased methadone doses. Its usefulness should be corroborated in a controlled trial.

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Section: Discussionmentioning

confidence: 99%