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Heroin Addiction and Related Clinical Problems: 2016, 18, 1 (pages: 45 - 50)

How to Improve a Poorly Running Opiate Substitution Therapy. Part 1: how Effective Are We?

Ulmer A.

Summary: Objective: In this paper the author introduces an evaluation of how good we actually are at treating patients. It could always be shown that patients receiving treatment with long-acting agonist opioid medications (LAAOMs) have a much better outcome than patients left untreated. But, compared with people who have no addiction disease, especially those with some other chronic illness, many patients receiving LAAOM treatment suffer, in fact, from a substantial difference in their quality of life. This comparison is the essential benchmark. Aim is a life that is as unimpaired by any illness as possi-ble. Methods: The status of addiction patients has been documented regularly, through the use of a 15-step impression scale in our practice for >20 years. In this study we followed up by evaluating the average of all recorded ratings of 109 patients of whom we had especially detailed case histories and a development diagram based on these documentations. In addition, our evaluation was divided up into the first and second half of treatment, as well as including a review of the last three years to examine whether the treatment period had exerted an influence. Results: The average of all evaluations was 6.61 ± 2.0 on the 15-step scale, which was on the borderline between “better, but not good” and “not completely good”. The average difference between the average values recorded for the first and second halves was no more than 0.95 ± 1.7. There was no correlation with the length of therapy. No distinctive improvement emerged until the last three years, where the mean value was at 8.61 ± 2.1, 2.45 better than that recorded in the first half of treatment, and only 21.6% of the cases reviewed satisfied the criteria for the evaluation “not good”. Conclusion: The evaluation shows alarmingly bad treatment results, even in a practice that included individual patient guidance. A distinct improvement only emerged in the final years of treatment, after the optimization of several treatment measures. There is a considerable need for improvement in many forms of treatment with LAAOMs.