Abstract
Background objectives: Since the beginning of the 1990 s the number of treated opioid addicts has markedly increased in Switzerland. This study examines the cause of health service utilisation of one specific type of treatment - heroin-assisted maintenance - the length of stay in this kind of treatment, and characteristics of admissions and discharges.
Methods and sample: Data on all admissions into and discharges from heroin-assisted treatment were collected from the start of this treatment modality on January 1, 1994 to December 31, 2001. These data were used to calculate length of stay, and number of patients at the end of each calendar year. Data were analysed according to sex and age and the Kaplan-Meier survival statistics were calculated. Finally, the discharges from 1994 to 1998 were compared to the discharges of 1999 up to December 2001.
Results: Since the introduction of heroin-assisted treatment, the number of patients in this form of treatment has markedly increased. Simultaneously, the average age of the patients entering treatment increased, whereas the proportion of women decreased continually. Compared to the earlier phase (1994-1998), in the last three years fewer patients terminated treatment at an early stage (within the first 4 months).
Conclusions: Substitution programmes are the most common form of treatment for opioid dependence in Switzerland. The increase in the average age of patients in this treatment modality as well as in the abstinence-oriented treatment at admission may be interpreted favourably as an indicator that fewer less young people are opioid dependent than at the beginning of the 1990 s. The decrease in the proportion of females may be an indicator that females were overrepresented in heroin-assisted treatment at the beginning of this treatment modality and that the proportion gradually became more similar to the proportion in the opioid-dependent population as a whole. The decrease of early treatment terminations can be seen as positive, since with longer length of stay the probability of changing into abstinence-oriented treatment is becoming more probable.
Gschwend, P