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Heroin Addiction and Related Clinical Problems: 2005, 07, 4 (pages: 23 - 30)

Primary care physicians and addiction treatment in Germany. Decentralization and take-home policy

Ulmer A.

Summary: Medical knowledge is not always discovered in universities and laboratories, before finally trickling down to primary care physicians. In some cases, the very opposite is true. Even in Germany, primary care physicians have sometimes been the first to develop new methods of treatment and introduce them in day-to-day medical practice. Unfortunately, the German medical system is unaccustomed to listening to their voice. As a result, new treatment methods introduced by this route meet with specific difficulties. Maintenance therapy for drug addicts was introduced in Germany in the 1980s, mainly by primary care physicians in the face of major resistance from the medical establishment. The need to take action was high, however, and primary care physicians were the professionals who felt this most keenly. Increasing numbers of primary care physicians started putting patients on maintenance therapy. Dihydrocodeine was the agent most frequently chosen, as methadone was prohibited until 1992. Responses were excellent for committed physicians who ensured that the necessary arrangements were in place. However, because of the lack of integration in established medical practice, unstructured prescription was rife, leading to new problems and culminating in a series of deaths. The official reaction was to tighten the regulations, with the consequence that most primary care physicians have given up. Maintenance is now predominantly offered by special maintenance centers, leading to a strong concentration of these specific patients. France and Croatia, but also other countries show us ways out of this dilemma. Decentralized, very liberal maintenance policies in France make maintenance easy and successful. We can learn, that a good support system for the practitioners helps to avoid quality problems, crucially, from the Croatian model.