Die Substitutionstherapie ist die evidenzbasierte Erstlinientherapie bei
Opioidabhängigkeit, einer chronisch-rezidivierenden Erkrankung mit hoher
Morbidität und Mortalität. Durch die kontrollierte Gabe langwirksamer Agonisten
wie Methadon, Levomethadon oder Buprenorphin – in speziellen Fällen auch
Diacetylmorphin – werden die körperliche und psychische Gesundheit stabilisiert,
das Überdosierungsrisiko gering gehalten und eine soziale Reintegration
gefördert.
Abstract
Opioid use disorder (OUD) is a chronic, relapsing condition associated with high
morbidity and mortality, primarily due to respiratory depression and overdose.
In Germany, approximately 160,000 people are affected by opioid dependence, with
significant variation across regions. Opioid Agonist therapy (OAT), also known
as opioid agonist treatment (OAT), is the internationally recognized first-line
therapy for OUD. It involves the medically supervised administration of
long-acting opioid agonists such as methadone, levomethadone, buprenorphine, or
— under strict conditions — diacetylmorphine (heroin) and aims to stabilize
physical and mental health, reduce illicit opioid use, and support social
reintegration.
The legal framework for OAT in Germany is defined by the Narcotic Drugs Act
(BtMG), the Narcotic Drugs Prescription Ordinance (BtMVV) and guidelines issued
by the Federal Medical Association and the Joint Federal Committee (GBA). These
regulations stipulate the qualifications required for prescribers, conditions
for supervised daily dosing, and criteria for take-home prescriptions.
Psychosocial support is strongly recommended. OAT has proven effective in
reducing mortality, improving quality of life, and lowering the prevalence of
infectious diseases among people with OUD. Special regulations apply to
substitution with diacetylmorphine, which is reserved for patients with severe
treatment-resistant opioid dependence. Despite clear benefits and legal clarity,
access to OAT is unevenly distributed in Germany, with rural areas facing
significant gaps in care. Expanding provider capacity and increasing the
flexibility of treatment delivery remain key priorities to ensure comprehensive
and equitable care for individuals affected by OUD.
Schlüsselwörter
illegal - Opioid - Drogenabhängigkeit - Substitution - Opiat
Keywords
illegal - opioids - drug addiction - opioid agonist treatment
