Original substance substitution
Original substance substitution refers to the medical prescription of an ( addictive ) substance that is chemically equivalent to the substance that is already consumed, but which has been manufactured under medically justifiable circumstances.
Areas of application
The vast majority of all debates and attempts to substitute original substances revolve around the medical prescription of diacetylmorphine, which continues to play a significant role on the criminalized narcotics market under the trade name heroin .
The establishment of a controlled heroin-assisted treatment is based on the assumption discussed by addiction researchers that a number of heroin users are in such a state of neglect that they are no longer available for other - also low-threshold - offers of help such as methadone . This view is supported by studies on a long-term “ maturing out ” process, which can only be successful if the survival of the patient can be ensured until then.
As with methadone or codeine models , aspects of security policy also play a role in the distribution of heroin, arguing about the confidence that criminogenic behavior ( criminal procurement , promotion of the narcotics, weapons and prostitution markets) can be influenced for the benefit of the general public.
history
Switzerland is the pioneer of original substance substitution, which has been able to collect data on the actual effects of heroin use (diamorphine-assisted treatment) in several studies since 1992 . In several referendums, the Swiss electorate approved these models and rejected opposing positions with the majority of votes and status, most recently the referendum of the youth without drugs group .
From 2002 to 2007 Germany carried out a drug study, the outcome of which was the proven suitability and approval of diamorphine as a prescription narcotic. Any further legalization of diamorphine was and is not yet planned.
On May 28, 2009, the inclusion of diamorphine-assisted treatment in standard care was decided by the Bundestag with 349 votes in favor and 198 against.
The drug studies, known as model projects, in seven German cities that had existed up to this point were then transferred to standard care. In 2010, the Federal Joint Committee (G-BA) made up of statutory health insurance physicians and health insurance companies included treatment and medication in the health insurance company's catalog of services. Despite this, almost four years after the law was passed, not a single awarding authority has been added in Germany. In contrast to many charities and professional associations who advocate nationwide implementation of the law, the implementation of this new legal option has so far hardly or not at all been tackled by the municipalities. This has in particular to do with the fact that in the G-BA the National Association of Statutory Health Insurance Physicians (KBV) and the Central Association of Statutory Health Insurance Funds (GKV) significantly increased some of the requirements for heroin therapy - compared to those previously in the model project - against resistance, especially from patient representatives have made more expensive. In particular, the new requirements that the registration offices - regardless of allocation times and number of patients - have to be staffed at least twelve hours a day and have at least three full-time medical positions represent a difficult obstacle for many municipalities. A cost-covering implementation of the new law is therefore almost only possible if the diamorphine allocation can be integrated into existing, larger substitute outpatient departments, hospitals, group practices, etc. In August 2011, the federal government felt compelled to emphasize that it "would welcome it if there were further locations in Germany for the target group of diamorphine-supported substitution treatment", but has not yet announced a review of these administrative obstacles.
Positions of the parties (Germany)
SPD
The SPD was during its participation in the federal government drug policy direction of the Federal Minister of Health Ulla Schmidt and the Drug Commissioner of the Federal Government. A "take-home regulation" previously provided for in the draft law (giving the drug to patients for a certain period of time, e.g. over the weekend), which would have significantly reduced the costs required for the awarding of contracts, ultimately failed due to resistance from the SPD . At the state level, the SPD has seldom taken any initiative.
CDU / CSU
The CDU sees no advantages in the inclusion of the original substance substitution in the instruments of addiction medical help. She rates the final report of the Swiss trials as a failure. This position is not shared by all CDU politicians. The Lord Mayor of Frankfurt , Petra Roth (CDU), has repeatedly been a pioneer in turning away from the declared prohibitionist line when she supported the establishment of low-threshold drug aid offers.
The CSU puts the heroin study in the context of the decriminalization of cannabis and the establishment of drug consumption rooms . Likewise, the original substance substitution is not seen as a substitution and is rejected as an addiction extension.
Alliance 90 / The Greens
Bündnis 90 / Die Grünen (Alliance 90 / The Greens) provided Christa Nickels, the first drug commissioner in the first red-green federal government , who strongly advocated the creation of original substance substitution programs. At the municipal and state level, the implementation of low-threshold drug aid offers is still part of the Green Party's program. Bündnis 90 / Die Grünen advocates changing the annex to the BtMG in order to expand the distribution of heroin into a permanent offer of help.
FDP
The FDP calls after the evaluation of the results of the 2002 study tarnished be controlled distribution of heroin now to take this form of treatment in the standard care.
The left
The Left assumed the heroin study would be successful and supported the necessary amendment to the Narcotics Act . In the federal states with participation in the state government, there were no locations for participation in the drug study. This was justified by the lack of need for such a facility.
Pirate party
On the basis of the results of the drug studies as well as many well-founded scientific studies at home and abroad, the Pirate Party demands that controlled administered diamorphine be established as a drug as part of an effective therapy and as a further low-threshold component in the treatment of addicts. The PIRATES demand u. a .: - The currently high entry barriers to diamorphine programs must be removed. More consumers, including those with less harmful consumption patterns, need access.
- In addition to injection, inhalation and oral ingestion in tablet form must also be permitted.
- More facilities need to be created to provide diamorphine treatments. The current specifications for the facilities must be revised.
- Intensive psychosocial support and, if necessary, a range of therapies for clients must be ensured.
Bibliography
- Federal Office of Public Health (Bern, Switzerland): Medical Prescription of Narcotics - Practical Implementation and Most Important Results, Verlag Hans Huber, ISBN 3-456-82910-8
- A. Uchtenhagen et al .: Prescription of Narcotics for Heroin Addicts - Key Results of the Swiss Cohort Study, Karger Verlag, ISBN 3-8055-6790-1
- André Seidenber, Ueli Honegger: Methadone, Heroin and Other Opioids - Medical Manual for Outpatient Opioid-Supported Treatment, Verlag Hans Huber, ISBN 3-456-82908-6
Web links
swell
- ↑ http://npl.ly.gov.tw/pdf/6887.pdf
- ↑ Until then, the affected cities bore these costs. http://www.rp-online.de/gesundheit/news/Diamorphin-wird-kuenftig-von-Krankenkassen-beaid_aid_833843.html
- ↑ The German Medical Association (BÄK), the Federal Chamber of Psychotherapists (BPtK), the Arbeiterwohlfahrt, the Professional Association of German Psychiatrists, the Paritätische Wohlfahrtsverband, Caritas u. a. took a unanimously positive position on diamorphine-supported treatment. See the websites and announcements of the individual associations on the subject of "Diamorphine allocation". In Karlsruhe, where the continuation of the award was in jeopardy, it has now even been taken over by the Arbeiterwohlfahrt. see: http://www.ka-news.de/region/karlsruhe/Hoffnung-fuer-Heroinsuechtige-AWO-darf-Diamorphin-einsetzen;art6066,541739
- ↑ Archived copy ( Memento of the original from January 3, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ In many, even larger German cities, there are still no facilities of the required size, since the previous substitution there has been organized decentrally and is distributed among smaller medical practices and outpatient departments.
- ↑ http://www.aerzteblatt.de/v4/news/news.asp?id=47006 ( Page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ Archived copy ( memento of the original from August 20, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
