Heroingestützte Therapie für Opiatabhängige - weder Allheilmittel noch Teufelswerk

Abstract

Ethical, scientifical and practical problems concerning substitution treatment for opiate addicts involving heroin as substitution agent are discussed. Main scientific problems concern the impossibility to conduct a heroin trial as a classic biochemical double-blind experiment and the impossibility to completely rule out confounding (e.g. duration of contact with therapists, reactivity). In addition, there are political and ideological debates concerning such trials, which cause practical problems. Both points are illustrated with examples from different countries. The conclusions argue for a more rational consideration of the application of heroin within substitution treatment for opiate addicts. Also, we should try to build treatment systems in this field, where different kinds of therapeutic approaches are offered (including the use of other substitution agents and abstinence-oriented therapies) and where matching of patient and therapy will be based on scientific knowledge. © 2000, Georg Thieme Verlag Stuttgart. All Rights Reserved.