Orales Diacetylmorphin in der heroingestützten Behandlung

Abstract

Background: The oral diacetylmorphine (DAM) prescription in tablet form in the Swiss heroin-assisted treatment (sHAT) was regularly approved after positive experiences with galenic forms of DAM in single patient cases already in the middle of the 1990ties und after a thorough scientific evaluation study that resulted in high retention rates and comparatively low side effects in 2010. Aims: The present report aims at the summary of the pharmacologic characteristics of oral DAM, the analysis of the variation of oral DAM prescriptions in the sHAT in time and the description of practice experiences of the oral DAM prescription. Results: The percent of exclusively intravenous DAM prescribed patients decrease from 59.0% to 26.6% between 1999 and 2012. The oral DAM prescription (exclusively or in combination with otherwise dispensed DAM) doubled since 1999 (1999: 10.6%, 2012: 23.8%). Similarly, did the exclusively oral dispensary (2000: 7.1%, 2012: 13.3%). These trends are predominantly supported by the manufactures´ selling numbers of distributed immediate release DAM to the sHAT dispensary sites. Compared to the intravenous DAM, the oral DAM form is appropriate particularly for the harm reduced application in case of bad vein conditions due the omission of infection risks, in the existence of respiratory reductions (e.g. as a result of COPD) or as an alternative to the intramuscular application. Moreover, oral DAM possesses benefits compared to other opioids with undesirable side effects (there is no QTc-time-prolongation under the influence of DAM) or reduces sHAT dispensary site contacts in the presence of limited physical mobility. Exactly polymorbid and older sHAT patients can profit of the oral DAM prescription. Conclusions: The oral DAM application doubled in the sHAT in the investigated time frame and will presumably reach the one of exclusively parenteral application. The oral DAM prescription could improve the sHAT service by the omission or reduction of various complications that can occur during the intravenous DAM dispensary.