Care for people with addictions is at risk – 10-point plan presented
07.05.2020 14:04
Opioid addiction, for example through heroin use, is a serious societal problem. There are 160,000 opioid-dependent individuals in Germany, but only half of them are reached by substitution therapy, the successful standard treatment for heroin addiction. In the future, it is expected that even these individuals will no longer be adequately served (1,2). In addition to the negative consequences for the health and lives of those affected, this poses challenges for our society: overall societal costs, public safety, and social responsibility for vulnerable individuals. The COVID-19 pandemic is exacerbating this problem.
Therefore, a group of experts in addiction medicine and addiction support has addressed a 10-point position paper with proposed solutions to policymakers, physicians, pharmacists, and health insurance providers. They are calling for the creation of the necessary framework to ensure the care of these chronically ill individuals. The "Initiative for Substitution Care for Opioid-Dependent Patients" is supported by 22 professional societies, patient organizations, other bodies, and the Federal Government's Drug Commissioner, Daniela Ludwig. Sanofi Germany is also among the supporters.
Highly effective treatment, special requirements
The effectiveness of substitution therapy for opioid dependence is well-established scientifically (3,4,5,6). At the heart of this complex, interdisciplinary treatment approach, alongside psychosocial support, is the administration of a substitution medication. Substitution therapy contributes to stabilizing health, helps prevent deaths, and enables patients to participate in social life. However, the provision of this service is at risk due to the declining number of physicians prescribing substitution therapy, driven by age. There are already districts throughout Germany where no physicians prescribing substitution therapy are practicing. The main reason for this is the lack of appeal of substitution treatment, especially for young physicians, as opioid dependence and addiction medicine are stigmatized. Furthermore, the bureaucratic burden of ensuring drug safety is considerable.
Pact for Substitution Required
A key demand is to better adapt the financial, organizational, and regulatory framework to the specific needs and services of substitution therapy in order to attract more physicians to provide this type of treatment. The goal is also to strengthen networking and expand the delegation of substitution therapy dispensing to pharmacies, addiction clinics, drug support facilities, and nursing and care homes. This requires a more consistent approach to new methods and the collaborative efforts of all healthcare providers and decision-makers. This includes not only the physicians providing substitution therapy and their governing bodies, but also a broad alliance of social welfare organizations, health insurance funds, professional associations, and government and political bodies at both the state and federal levels. Furthermore, the authors call for a significant strengthening of the importance of addiction medicine in medical school curricula and postgraduate training.
Challenges in the COVID-19 pandemic
The outbreak of the COVID-19 pandemic has presented further challenges for opioid substitution therapy providers. Practices must strike a balance between ensuring the care of this vulnerable patient group and infection control. Treatment must be conducted with care, adhering to strict regulations regarding controlled substance safety. Many of the patients with substance use disorders, often with comorbidities, belong to the high-risk group for COVID-19. Since approximately half of the substitution therapy patients visit the practice daily for their medication, both the practice teams and the patients themselves are exposed to an increased risk of infection. The 10-point plan therefore also includes proposals for managing the current crisis, aiming to reduce the frequency of visits to the practice and to provide care as close to patients' homes as possible.
The „10-point paper for resolving the supply crisis in substitution therapy“ can be found on the websites of supporters, e.g. www.substitutionsportal.de/Versorgung or can be requested from the coordinator of the „Initiative for Substitution Care for Opioid-Dependent Patients“, Sieglinde Schneider: [email protected]