Heinz Andreas, Gutwinski Stefan, Krausz Michael, Ernst Gernot, Vogel Marc, Scherbaum Norbert
Department of Psychiatry and Neurosciences, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Department of Psychiatry, University Hospital Charité, St. Hedwig Hospital Berlin, Berlin, Deutschland.
Nervenarzt. 2024 Sep;95(9):811-817. doi: 10.1007/s00115-024-01691-9. Epub 2024 Jul 15.
The number of persons using opioids has increased worldwide in the last decade, particularly the use of opioid analgesics in North America and Africa. In Germany, the prevalence of heroin addiction has remained relatively stable.
Narrative review of the literature.
Opioid-assisted maintenance treatment (OMT) with the established substances methadone, levomethadone, slow-release morphine and buprenorphine is recommended as the first-line treatment for heroin dependence. The OMT reduces the use of heroin, mortality and individual suffering and improves the quality of life and physical health. A diamorphine and heroine-assisted treatment is an option for people who do not benefit from conventional OMT. An alternative to the use of diamorphine could be treatment with hydromorphone hydrochloride. The regulations on carrying out maintenance treatment in the Controlled Substances Prescription Act and the guidelines of the Federal Medical Association in Germany have been loosened based on the experiences of the COVID-19 pandemic, for example with respect to take-home prescriptions. There is an ongoing intensive discussion on how to deal with the decreasing number of outpatient clinics offering OMT.
The first-line treatment for opioid addiction is opioid-assisted substitution treatment, including diamorphine and heroin-assisted treatment. Long-acting depot medications and implants still play a subordinate role.
在过去十年中，全球使用阿片类药物的人数有所增加，尤其是北美和非洲的阿片类镇痛药的使用。在德国，海洛因成瘾的患病率一直相对稳定。
对文献进行叙述性综述。
推荐使用美沙酮、左美沙酮、缓释吗啡和丁丙诺啡等既定药物进行阿片类药物辅助维持治疗（OMT），作为海洛因依赖的一线治疗方法。OMT可减少海洛因的使用、死亡率和个人痛苦，并改善生活质量和身体健康。二醋吗啡和海洛因辅助治疗是对传统OMT无反应者的一种选择。使用盐酸氢吗啡酮可能是二醋吗啡治疗的替代方法。基于新冠疫情的经验，德国《管制物质处方法》中关于开展维持治疗的规定以及德国联邦医学协会的指南已经放宽，例如在带回家处方方面。关于如何应对提供OMT的门诊诊所数量减少的问题，正在进行深入讨论。
阿片类药物成瘾的一线治疗是阿片类药物辅助替代治疗，包括二醋吗啡和海洛因辅助治疗。长效长效药物和植入物仍起次要作用。
