Abstract:
BACKROUND: The intended effects of substitution therapy may be achieved as the opioid receptors of opioid-dependent patients are bound with a non-psycho tropical opioid, thus blocking euphoric effects, preventing withdrawal syndrome and leading to physical health stabilization. Moreover, the cessation of drugrelated crime and removal from the drug scene facilitate social reintegration. Concurrently, the provision of psychosocial attendance supports patients with their social problems and psychological disorders.
OBJECTIVES: To evaluate the effectiveness of opioid replacement therapy, in particular, to compare methadone-maintained opiate users with codeine-maintained opiate users in order to identify significant differences.
METHODS: 86 opioid replacement patients, residing in the District of Tübingen, were surveyed on the case history of following concepts by means of a standardized questionnaire: general health, life-style with regard to residence, social contacts, employment, financial and legal situation. Notably, changes in life-style were reviewed by comparing the current situation to the situation prevailing prior to treatment. 61 of 102 items were explored with the objective of identifying significant differences between methadone-maintained patients and codeine-maintained patients.
RESULTS: The subjects surveyed were susceptible to a number of major medical conditions and social challenges. The following common concerns were prevalent: often occurring chronic somatic illnesses, psychic disorders and social problems. The opioid replacement therapy was enormously effective in reducing the patients' medical concerns, drug use and criminal activities. However, the provided psychosocial support was either not called upon or was perceived by the patients as insufficient.
For 24 out of the 61 explored items, significant differences between methadone-maintained patients and codeine-maintained patients were identified. For example, codeine-maintained opiate users experience less health problems and are much better socially integrated. This is most likely implicated by the criteria adopted to select appropriate patients. In contrast to methadone, codeine demonstrates a short half-life, and therefore requires dosing several times daily. Consequently, codeine has to be handed over to the patient to take with him. Against the background of the legal regulations and guidelines in Germany at that time, the obvious procedure for a general practitioner was to dispense a several-day supply of codeine, thus sparing patients a daily doctor's appointment. Naturally this delivery mode bears a high risk for abuse therefore, it was only appropriate for stable and reliable patients.
Due to its shorter half-life, theoretically, methadone appears to be superior to codeine since it produces less fluctuation in agent levels. Thus, a better compatibility may be concluded resulting in fewer side effects and fewer disorders of the central nervous system. On the contrary, these findings were not evidenced in the analysis.
CONCLUSIONS: Opioid replacement therapy is effective in achieving the intended therapeutic goals, namely, improvement of general health, social reintegration and rehabilitation. However, it requires considerable time and intensive therapeutic care. Primarily, deficiencies were observed in psychosocial counselling. In order to further improve outcomes, more competent services that specifically target the needs of addicts are essential. Moreover, special emphasis should be placed on a psychotherapeutic approach.
Although methadone, by virtue of its pharmacological characteristics, appears to be superior to codeine, the hypothesis could not be confirmed by the study. Therefore, the call for forcing successfully with codeine-treated patients to switch to methadone cannot be justified medically.