Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: a naturalistic study in 2694 patients.
BACKGROUND
In many countries, buprenorphine and methadone are licensed for the maintenance treatment (MT) of opioid dependence. Despite many short-term studies, little is known about the long-term (12-month) effects of these treatments in different settings, i.e. primary care-based (PMC) and specialized substitution centers (SSCs).


OBJECTIVE
To describe over a period of 12 months: (1) mortality, retention and abstinence rates; (2) changes in concomitant drug use, somatic and mental health; and (3) to explore differences between different types of provider settings.


METHODS
12-Month prospective-longitudinal naturalistic study with four waves of assessment in a prevalence sample of N=2694 maintenance patients, recruited from a nationally representative sample of N=223 substitution physicians.


RESULTS
The 12-month retention rate was 75%; the mortality rate 1.1%. 4.1% of patients became "abstinent" during follow-up. 7% were referred to drug-free addiction treatment. Concomitant drug use decreased and somatic health status improved. No significant improvements were observed for mental health and quality of life. When controlling for initial severity, small PMC settings revealed better retention, abstinence and concomitant drug use rates.


CONCLUSIONS
The study underlines the overall 12-month effectiveness of various forms of agonist MT. Findings reveal relatively high retention rates, low mortality rates, and improvements in most 12-month outcome domains, except for mental health and quality of life. PMC settings appear to be a good additional option to improve access to MTs.
Wittchen
Hans-Ulrich
HU
Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzerstrasse 46, 01187 Dresden, Germany. wottchen@psychologie.tu-dresden.de
Apelt
Sabine M
SM
Soyka
Michael
M
Gastpar
Markus
M
Backmund
Markus
M
Gölz
Jörg
J
Kraus
Michael R
MR
Tretter
Felix
F
Schäfer
Martin
M
Siegert
Jens
J
Scherbaum
Norbert
N
Rehm
Jürgen
J
Bühringer
Gerhard
G
D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002047:Buprenorphine / Q000627:therapeutic use*; D002391:Catchment Area, Health; D005240:Feasibility Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006556:Heroin Dependence / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012153:Retention, Psychology
D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone