Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain.
Bull World Health Organ. 2013 Feb 1;91(2):136-41. doi: 10.2471/BLT.12.111054.
During the 1980s, Spain had very strict laws limiting access to opioid agonist maintenance treatment (OAMT). Because of this, mortality among people who used illicit opioids and other illicit drugs was high. Spain was also the European country with the highest number of cases of acquired immunodeficiency syndrome transmitted through illicit drug injection.
The rapid spread of human immunodeficiency virus (HIV) infection among people using heroin led to a shift from a drug-free approach to the treatment of opioid dependence to one focused on harm reduction. A substantial change in legislation made it possible to meet public health needs and offer OAMT as part of harm reduction programmes in the public health system, including prisons.
Legislative changes were made throughout the country, although at a different pace in different regions.
Legal changes facilitated the expansion of OAMT, which has achieved a coverage of 60%. A parallel reduction in the annual incidence of HIV infection has been reported. Reductions in morbidity and mortality and improved health-related quality of life have been described in patients undergoing OAMT.
The treatment of opioid dependence has been more heavily influenced by moral concepts and prejudices that hinder legislation and interfere with the implementation of OAMT than by scientific evidence. To fulfil public health needs, OAMT should be integrated in harm reduction programmes offered primarily in public facilities, including prisons. Longitudinal studies are needed to detect unmet needs and evaluate programme impact and suitability.
20 世纪 80 年代，西班牙制定了非常严格的法律来限制阿片类激动剂维持治疗（OAMT）的准入。因此，滥用非法阿片类药物和其他非法药物的人群死亡率很高。西班牙也是欧洲因非法药物注射而感染艾滋病的病例数最高的国家。
在使用海洛因的人群中，人类免疫缺陷病毒（HIV）感染迅速蔓延，这促使人们从无毒品方法转向以减少伤害为重点的阿片类药物依赖治疗。立法的重大变化使得满足公共卫生需求并提供 OAMT 成为可能，将其作为公共卫生系统（包括监狱）减少伤害方案的一部分。
全国各地都进行了立法改革，尽管不同地区的步伐不同。
法律变化促进了 OAMT 的扩张，其覆盖率达到了 60%。据报道，HIV 感染的年发病率也有所下降。接受 OAMT 的患者的发病率、死亡率和健康相关生活质量都有所改善。
阿片类药物依赖的治疗受到道德观念和偏见的影响更大，这些观念和偏见阻碍了立法，干扰了 OAMT 的实施，而不是受到科学证据的影响。为了满足公共卫生需求，OAMT 应纳入以公共设施（包括监狱）为主的减少伤害方案。需要进行纵向研究来发现未满足的需求，并评估方案的影响和适用性。
