Arud Centre for Addiction Medicine, Zurich, Switzerland.
Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland.
Addiction. 2024 Aug;119(8):1421-1429. doi: 10.1111/add.16503. Epub 2024 Apr 21.
Legal regulations for dispensing in Swiss heroin-assisted treatment were relaxed during the COVID-19 pandemic, allowing prolonged take-home of up to 7 days instead of two to reduce patient contact and the risk of infection. Our study aimed to measure the consequences of this new practice.
DESIGN, SETTING AND PARTICIPANTS: This was a retrospective cohort study set in Switzerland's largest outpatient centre for opioid agonist therapy. One hundred and thirty-four (72.4%) of the 185 patients receiving oral diacetylmorphine (DAM) participated in the study.
Through the utilization of electronic medication prescription and dispensing software, as well as the electronic medical record, the following data were extracted to explore the potential consequences: dose of DAM, the number of antibiotic therapies, emergency hospitalizations and incarcerations. Age, gender, prescriptions for psychotrophic drugs and additional prescription for injectable DAM were tested to assess an increased risk of losing prolonged take-home privileges. Data in the year since prolonged take-home (period 2) were compared with data from the equivalent prior year (period 1).
DAM take-home was not associated with a change in DAM dose (P = 0.548), the number of emergency hospitalizations (P = 0.186) or the number of incarcerations (P = 0.215); 79.1% of all patients were able to maintain their extended take-home privileges. However, patients who had injectable DAM experienced significant reductions in their prolonged take-home privileges.
Allowing patients to take home oral diacetylmorphine for up to 7 days as treatment for opioid use disorder does not appear to pose any demonstrable health risk. It is generally manageable for the large majority of patients. However, careful consideration of prolonged take-home for patients with additional injectable diacetylmorphine is recommended, as these patients are more likely to lose take-home privileges.
在 COVID-19 大流行期间，瑞士放宽了海洛因辅助治疗中的配药法律规定，允许患者将口服二乙酰吗啡带回家的时间延长至 7 天，而不是原来的 2 天，以减少患者接触和感染风险。我们的研究旨在衡量这一新做法的后果。
设计、地点和参与者：这是一项在瑞士最大的门诊阿片类药物激动剂治疗中心进行的回顾性队列研究。在接受口服二乙酰吗啡（DAM）治疗的 185 名患者中，有 134 名（72.4%）参与了研究。
通过利用电子药物处方和配药软件以及电子病历，提取以下数据来探索潜在的后果：DAM 的剂量、抗生素治疗的次数、紧急住院和监禁。测试了年龄、性别、精神药物处方和注射用 DAM 的额外处方，以评估失去延长带回家特权的风险增加。将延长带回家后的一年（第 2 期）的数据与前一年同期（第 1 期）的数据进行比较。
DAM 带回家并没有改变 DAM 的剂量（P=0.548）、紧急住院的次数（P=0.186）或监禁的次数（P=0.215）；所有患者中有 79.1%能够维持其延长带回家的特权。然而，接受注射用 DAM 的患者明显减少了延长带回家的特权。
允许患者将口服二乙酰吗啡带回家长达 7 天用于治疗阿片类药物使用障碍似乎不会带来任何明显的健康风险。对于绝大多数患者来说，这是可以管理的。然而，对于那些有额外注射用二乙酰吗啡的患者，建议谨慎考虑延长带回家的时间，因为这些患者更有可能失去带回家的特权。
