[Burden of disease and level of patient's medical care in substitution treatment for opiates].
OBJECTIVE
Within the framework of an interdisciplinary cooperation, the authors set up an on-site medical service provider in a specialized methadone substitution center in Germany. Here, they report on the prevalence of infectious and noninfectious diseases, and the vaccination status of substituted heroin-dependent patients.


METHODS
All patients who visited the medical care service provider between February 2008 and December 2008 were included in this study.


RESULTS
Ten patients (7%) were seropositive for the hepatitis A virus. Two patients (1.3%) suffered from chronic hepatitis B; 40 patients (27%) were cured after a hepatitis B infection. Additionally, 99 patients (68%) were infected with hepatitis C virus (HCV), and 41 patients (28%) had active hepatitis C. Furthermore, 48 hepatitis C patients (33%) were cured. Of those, 25 patients (17%) cleared the virus spontaneously and 23 (16%) after ribavirin/interferon combination therapy. Ten (7%) of 146 patients were infected with the human immunodeficiency virus (HIV). Of those, four patients had active hepatitis C, and five patients were cured after a hepatitis C infection. 18 patients (12%) were vaccinated against hepatitis A and 28 (19%) against hepatitis B. Two of the 41 patients with chronic hepatitis C were vaccinated against hepatitis A. The most frequent noninfectious diagnoses were arterial hypertension (n = 28), bronchial asthma (n = 8), and diffuse liver parenchymal damage (n = 12).


CONCLUSIONS
These results emphasize that i.v. drug users on substitution therapy are an underserved collective with a high prevalence of disease. The challenge consists in facilitating this population access to internistic and infectious disease service. The offer of an on-site medical service was well accepted. This is essential for an ongoing reduction of HIV and HCV prevalence in the drug users.
Müller
Matthias C
MC
Infektionsabteilung, Medizinische Poliklinik, Campus Innenstadt, Klinikum der Universität München, München. matthias.mueller@med.uni-muenchen.de
Pichler
Matthias
M
Martin
Gabi
G
Plörer
Diana
D
Winter
Catja
C
Pogarell
Oliver
O
Bogner
Johannes R
JR
D000328:Adult; D001249:Asthma / Q000453:epidemiology; D015897:Comorbidity; D003299:Cooperative Behavior; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D015658:HIV Infections / Q000453:epidemiology*; D006525:Hepatitis, Viral, Human / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D033183:Interdisciplinary Communication; D008107:Liver Diseases / Q000453:epidemiology; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D010348:Patient Care Team; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage
D009294:Narcotics; D014761:Viral Hepatitis Vaccines; D008691:Methadone