Opiate replacement therapy

Opiate Replacement Therapy (ORT) is the medical procedure of replacing an illegal opiate drug such as heroin with a longer acting but less euphoric opiate, usually methadone or buprenorphine, that is taken under medical supervision. In some countries (e.g. Switzerland, Austria) patients incompatible with methadone may be treated with slow-release morphine. In Germany, patients were treated off-label with Dihydrocodeine for many years since MMT (methadone maintenance treatment) was made legal but in the late 80s. Nowadays there are still a few hundred patients receiving DHC.

Some formulations of buprenorphine are manufactured in pill form with the opiate antagonist Naloxone to prevent addicts from crushing the tablets and injecting them instead of taking them sublingually (under the tongue).

The driving principle behind ORT is that an opiate addict will be able to regain a normal life and schedule while being treated with a substance that stops him from experiencing withdrawal symptoms and cravings, but doesn't provide strong euphoria. In many countries regulations require that ORT should be applied for a limited time only, as long as needed for the patient to consolidate his economic and psychosocial situation. (Patients suffering from HIV/AIDS or Hepatitis C are usually excluded from this demand.) In practice however only a small fraction of patients manage to attain abstinence.

ORT has been shown to be the treatment most effective in improving the health and living condition of patients. It is also the most effective in reducing mortality [Michel et al: [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1797169 Substitution treatment for opioid addicts in Germany] , Harm Reduct J. 2007; 4: 5.] as well as overall costs for society. (e.g. those caused by drug related crime, the prosecution thereof, the spreading of diseases, etc.)

ee also

Methadone#Methadone_maintenance_treatment

References