OST saves lives it s official! OST a key to HIV prevention Opioid Substitution Treatment in Germany A Story of Success
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1 XVIII International AIDS Conference, 2010 Vienna UNODC-GTZ Satellite Symposium: OST saves lives it s official! OST a key to HIV prevention Opioid Substitution Treatment in Germany A Story of Success Joerg Goelz Centre for HIV, Hepatitis and Addiction Medicine, Berlin DGS German Society of Addiction Medicine Hans-Günter Meyer-Thompson GTZ German Technology Cooperation
2 Harm Reduction in Germany Needle and syringe exchange by programmes and pharmacies Supervised Injection Facilities Opioid Substitution Treatment including psychosocial care Diamorphine Substitution Treatment Free access to HIV- and Hepatitis-Treatment Peer group counseling on safer use and safer sex OST in prisons (limited)
3 Rules for OST in Germany - Physicians with certificate (training of 50 hrs) - Mandatory: psychosocial care - Combined treatment of somatic and psychiatric diseases - Dispensing in clinics, offices and pharmacies - Urine analysis at regular intervals - Detoxification of non prescribed drugs and substances and concomitant maintenance of OST - Take-home-dosis after 6 months possible - Stable life (housing, income, job rehabilitation)
4 Rules for Diamorphine (Heroin) Substitution Treatment - Physicians with special training in DMT - High security facilities - Patients: > 23 years old and > 5 years of injecting heroin and failed MMT/BMT - Concomitant somatic and/or psychiatric diseases - 2 failed abstinence oriented therapies - 6 months of psychosocial care mandatory
5 Funding of opioid substitution treatment German Health Insurance System (doctors fee, psychiatric care, medication ) Municipal Social Budgets (psychosocial care ) German Federal Pension Fund (occupational rehabilitation, abstinence oriented treatment)
6 Europe: Provision of OST by office-based GPs TRENDS IN INJECTING DRUG USE IN EUROPA, European Monitoring Centre for Drugs and Drug Addiction, 2010
7 Germany:Specialisation of physicians providing OST certified OST-physicians, 500 physicians treating up to 3 IDU`s under supervision
8 Europe: Estimates of prevalence of IDU per 1000 population TRENDS IN INJECTING DRUG USE IN EUROPA, European Monitoring Centre for Drugs and Drug Addiction, 2010
9 Substances to be used in Germany Dihydrocodeine (DHC) L-Methadone D-/L-Methadone Buprenorphine LAAM Diamorphine Buprenorphine + Naloxone since 1980 since 1985 since 1991 since since 2002 since 2007 Bundesinstitut für Arzneimittel und Medizinprodukte - Federal Institute for Drugs and Medical Devices
10 Distribution of the opioids Bundesinstitut für Arzneimittel und Medizinprodukte - Federal Institute for Drugs and Medical Devices
11 Registered OST-patients in Germany Bundesinstitut für Arzneimittel und Medizinprodukte - Federal Institute for Drugs and Medical Devices
12 OST clients as percentage of the estimated problem opiod users TRENDS IN INJECTING DRUG USE IN EUROPA, European Monitoring Centre for Drugs and Drug Addiction, 2010
13 Europe: OST programmes in the community and the prison system 2007 TRENDS IN INJECTING DRUG USE IN EUROPA, European Monitoring Centre for Drugs and Drug Addiction, 2010
14 New HIV diagnosis in Germany by route of infection Robert-Koch-Institut, Berlin, Epidemiologisches Bulletin, 7. Juni 2010 / Nr. 22
15 New HIV-infections among IDU s according to regions of origin Robert-Koch-Institut, Berlin, Epidemiologisches Bulletin, 7. Juni 2010 / Nr. 22
16 HIV-prevalence among injecting drug users in Europe 2006/07 TRENDS IN INJECTING DRUG USE IN EUROPA, European Monitoring Centre for Drugs and Drug Addiction, 2010 TRENDS IN INJECTING DRUG USE IN EUROPA, European Monitoring Centre for Drugs and Drug Addiction, 2010
17 Reduction of death rate of IDU s in Germany Bundesministerium für Gesundheit - The Federal Ministry of Health, 2010
18 Conclusions I OST is integrated in the existing health care system Heroin substitution treatment needs public investments due tosecurity requirements OST is covered by compulsory health insurance OST and HR is (by the majority) politically supported by federal and local parliaments, police superintendents, medical associations and PH administrations
19 Conclusions II 50% of all IDU s are in OST Majority of HIV-infected IDU s are in OST OST leads to a low rate of HIV-prevalence in IDU s OST leads to a very low incidence among IDU s OST reduces the rate of fatal overdoses OST is still limited in German prisons and in some rural regions OST works!
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