Abstract
BackgroundOpiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society. Due to lessened restrictive admission criteria, the number of registered OST patients in Germany has increased continuously in the recent years, whereas the number of physicians providing OST has remained constant. Previous data already indicated a deteriorating situation in the availability or quality of OST delivered and that structural barriers impede physicians in actively providing OST. The present survey among a sample of primary care physicians in Germany aimed to identify and assess potential structural barriers for the provision of health care in the context of OST.MethodsAn anonymous written questionnaire was sent out to a sample of 2,332 physicians across Germany providing OST. Physicians contacted were identified through databases of the Federal State Chambers of Physicians and/or of the Federal Associations of Statutory Health Insurance Physicians. Data obtained were analysed descriptively.ResultsThe response rate was 25,5% and the majority of 596 physicians sampled viewed substantial problems in terms of the regulatory framework of OST care in the German context. Furthermore, financial remuneration, insufficient qualification, as well as inadequate interdisciplinary cooperation in the treatment of comorbidities of opiate substituted patients were regarded as problematic. The number of physicians providing OST in Germany is expected to substantially decrease in the near future.ConclusionDespite less restrictive admission criteria for OST in Germany, the legal regulation framework for OST is still a limiting factor through raising concerns on the provider and consumer side to be unable to adhere to the strict rules. To avoid future shortages in the provision of OST care on the system level in Germany, revisions to the legal framework seem to be necessary. In regards to adequate care for drug use-related infectious diseases and psychiatric comorbidities commonly found in opiate substituted patients, efforts are required to improve professional qualifications of physicians providing OST as well as respective interdisciplinary collaboration.
Highlights
The effectiveness of opiate substitution treatment (OST) and its substantial long-term benefits for patient and society in the treatment of opioid dependence are well documented
Small treatment units seem to be more common in rural areas, whereas over 80% of the large substitution treatment centres were located in urban areas; χ2 (2, n = 595) = 41.769, p < .001 (Table 1)
Our survey demonstrated the existence of structural barriers in the provision of Opiate substitution treatment (OST), and showed that these obstacles considerably limit the overall provision and uptake of OST
Summary
The effectiveness of opiate substitution treatment (OST) and its substantial long-term benefits for patient and society in the treatment of opioid dependence are well documented. Current prevalence estimations based on treatment, police and drug-related death data from 2011 suggest a population of up to 174,000 problem opiate users in Germany [9]. OST physicians have to register each patient at the Federal Narcotics Control Board (Bundesopiumstelle) and are obliged to document all relevant patient and treatment data (e.g. diagnoses, psychosocial counselling, frequencies and results of drug screenings and supervisions of additional use of psychotropic substances) [10]. Opiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society.
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