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Original article

Vol. 144 No. 1314 (2014)

Opioid maintenance therapy in Switzerland: an overview of the Swiss IMPROVE study

  • Jacques Besson
  • Thilo Beck
  • Gerhard A. Wiesbeck
  • Robert Hämmig
  • André Kuntz
  • Sami Abid
  • Rudolf Stohler
DOI
https://doi.org/10.4414/smw.2014.13933
Cite this as:
Swiss Med Wkly. 2014;144:w13933
Published
23.03.2014

Summary

BACKGROUND/AIMS: Switzerland’s drug policy model has always been unique and progressive, but there is a need to reassess this system in a rapidly changing world. The IMPROVE study was conducted to gain understanding of the attitudes and beliefs towards opioid maintenance therapy (OMT) in Switzerland with regards to quality and access to treatment. To obtain a “real-world” view on OMT, the study approached its goals from two different angles: from the perspectives of the OMT patients and of the physicians who treat patients with maintenance therapy. The IMPROVE study collected a large body of data on OMT in Switzerland. This paper presents a small subset of the dataset, focusing on the research design and methodology, the profile of the participants and the responses to several key questions addressed by the questionnaires.

METHODS: IMPROVE was an observational, questionnaire-based cross-sectional study on OMT conducted in Switzerland. Respondents consisted of OMT patients and treating physicians from various regions of the country. Data were collected using questionnaires in German and French. Physicians were interviewed by phone with a computer-based questionnaire. Patients self-completed a paper-based questionnaire at the physicians’ offices or OMT treatment centres.

RESULTS: A total of 200 physicians and 207 patients participated in the study. Liquid methadone and methadone tablets or capsules were the medications most commonly prescribed by physicians (60% and 20% of patient load, respectively) whereas buprenorphine use was less frequent. Patients (88%) and physicians (83%) were generally satisfied with the OMT currently offered. The current political framework and lack of training or information were cited as determining factors that deter physicians from engaging in OMT. About 31% of OMT physicians interviewed were ≥60 years old, indicating an ageing population. Diversion and misuse were considered a significant problem in Switzerland by 45% of the physicians.

CONCLUSION: The subset of IMPROVE data presented gives a present-day, real-life overview of the OMT landscape in Switzerland. It represents a valuable resource for policy makers, key opinion leaders and drug addiction researchers and will be a useful basis for improving the current Swiss OMT model.

References

  1. World Health Organization. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. 2009.
  2. Federal Office of Public Health (FOPH). Switzerland’s National Drugs Policy: The federal government’s third package of measures to reduce drug-related problems (MaPaDro III). 2006−2011.2006.
  3. Hedrich D. European report on drug consumption rooms. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA. 2004.
  4. Klingemann HK. Drug treatment in Switzerland: harm reduction, decentralization and community response. Addiction. 1996;91(5):723–36.
  5. Huissoud T, Rousson V, Dubois-Arber F. Methadone treatments in a Swiss Region, 2001-2008: a registry-based analysis. BMC Psychiatry. 2012;12:238.
  6. Dürsteler-MacFarland KM, Vogel M, Wiesbeck GA, Petitjean SA. There is no age limit for methadone: a retrospective cohort study. Subst Abuse Treat Prev Policy. 2011;6:9.
  7. Nordt C, Landolt K, Stohler R. Estimating incidence trends in regular heroin use in 26 regions of Switzerland using methadone treatment data. Subst Abuse Treat Prev Policy. 2009;4:14.
  8. United Nations Office on Drugs and Crome (UNODC). World Drug Report. 2011.
  9. Vogel M, Petitjean S, Borgwardt S, Wlesbeck GA, Walter M. Therapie der Opioidabhängigkeit: Ein Update. Schweizer Archiv für Neurologie und Psychiatrie. 2010;161(1):5–13.
  10. Federal Office of Public Health (FOPH). Substitution-assisted treatment in opioid dependence. October 2009.
  11. Stohler R, Nordt C, Falcato L, Dürsteler-MacFarland KM, Rössler W. Wie effektiv sind Methadonbehandlungen in Privatpraxen? Soz.- Präventivmed. 2004;49:276–80.
  12. Petitjean S, Stohler R, Déglon JJ, Livoti S, Waldvogel D, Uehlinger C, et al. Double-blind randomized trial of buprenorphine and methadone in opiate dependence. Drug Alcohol Depend. 2001;62(1):97–104.
  13. Uehlinger C, Déglon J, Livoti S, Petitjean S, Waldvogel D, Ladewig D. Comparison of buprenorphine and methadone in the treatment of opioid dependence. Swiss multicentre study. Eur Addict Res. 1998;4(Suppl 1):13–8.
  14. Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2008;(2):CD002207.
  15. Ducharme S, Fraser R, Gill K. Update on the clinical use of buprenorphine: in opioid-related disorders. Can Fam Physician. 2012;58(1):37–41.
  16. Stöver H. Barriers to opioid substitution treatment access, entry and retention: a survey of opioid users, patients in treatment, and treating and non-treating physicians. Eur Addict Res. 2011;17(1):44–54.
  17. Goulão J, Stöver H. The profile of patients, out-of-treatment users and treating physicians involved in opioid maintenance treatment in Europe. Heroin Addict Relat Clin Probl. 2012;14(4):7–22.
  18. Fischer G, Stöver H. Assessing the current state of opioid-dependence treatment in Europe: methodology of the European Quality Audit of Opioid Treatment (EQUATOR) project. Heroin Addict Relat Clin Probl. 2012;14(3):5–70.

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