Buprenorphin/Naloxon – Ergebnisse aus dem niedergelassenen Bereich^[*]

Zusammenfassung

Ziel:

Untersuchung zur Wirksamkeit, Akzeptanz, Verträglichkeit und Verbleiberate der Buprenorphin/Naloxon-Behandlung bei opioidabhängigen Patienten in einem ambulanten Setting.

Methode:

Die Untersuchung wurde in einem open-label, prospektiven, multizentrischen Design (25 Zentren) mit 307 Patienten über einen Untersuchungszeitraum von 12 Monaten durchgeführt. Dropouts wurden auf Prädiktoren für den Behandlungsabbruch analysiert.

Ergebnisse:

Die Retentionsrate betrug nach 12 Monaten 45,6%, wobei die höchste Retentionsrate Patienten mit Buprenorphinvorbehandlung aufwiesen. Die Dropout-Analyse erbrachte 3 signifikante Prädiktoren für einen vorzeitigen Studienabbruch: Eine kürzere Dauer der Heroinabhängigkeit (p=0,038), ein geringeres Alter beim Erstkontakt mit Heroin (p=0,028) sowie eine höhere Einstellungsdosierung (p=0,017). Etwa zwei Drittel der Befragten zeigten sich mit der Behandlung sehr zufrieden bzw. zufrieden, wobei die Selbsteinschätzung mit der Fremdeinschätzung der Mediziner nicht deckungsgleich war.

Schlussfolgerungen:

Die Untersuchung zeigt, dass noch ein erheblicher Schulungsbedarf zur Buprenorphin/Naloxon-Medikation besteht, insgesamt das Ergebnis bezüglich Retentionsrate und Zufriedenheit mit Ergebnissen chronischer Erkrankungen im Einklang steht.

Abstract

Objective:

Patients receiving office-based buprenorphine/naloxone maintenance treatment for opiate dependence were examined over a time span of 12 months in order to determine treatment efficacy, acceptance, tolerance and retention rates.

Methods:

An open-label, prospective multicenter trial (25 centres) was conducted including 307 patients with a DSM-IV diagnosis of opiate dependence with or without prior treatment. Study dropouts were analysed for predictors of treatment discontinuation.

Results:

The overall retention rate after 12 months was 45.6%. Patients with prior buprenorphine experience showed the highest retention rate. 3 significant predictors for premature study dropout were detected: a shorter duration of ­heroin dependence at study entrance (p=0.038), younger age at initial drug exposure (p=0.028) and a higher initial dose of maintenance medication (p=0.017). Two thirds of patients reported to be satisfied with treatment. However, self-­assessment was not congruent with assessments provided by doctors.

Conclusions:

The study shows that there is a considerable need for further training concerning buprenorphine/naloxone treatment. Results on patient satisfaction and retention are comparable to other chronic conditions.

Schlüsselwörter

Buprenorphin/Naloxon - Opioiderhaltungstherapie - Patientenzufriedenheit

Key words

buprenorphine/naloxone - maintenance treatment - opioid dependence

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