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Suchttherapie 2020; 21(02): 85-97
DOI: 10.1055/a-1153-3988
Schwerpunktthema
© Georg Thieme Verlag KG Stuttgart · New York

Die Opioidkrise in den USA: Ausmaß, Ursachen, Gegenmaßnahmen und die europäische Situation im Vergleich

The US Opioid Crisis: Extent, Causes, Counter-Measures and the European Situation in Comparison
Ulrich W. Preuss
1   Vitos Klinik Psychiatrie und Psychotherapie, Herborn und Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität, Halle-Wittenberg
,
Friedrich M. Wurst
2   Psychiatrische Universitätsklinik Basel, Universität Basel, Schweiz
,
Jessica Wei Mooi Wong
3   Klinik am Homberg, Bad Wildungen
› Author Affiliations
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Publication History

Publication Date:
13 May 2020 (online)

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Zusammenfassung

Der Opioid-Missbrauch und die Todesfälle durch Überdosierung haben in den USA krisenartige Ausmaße angenommen. Allein im Jahr 2017 starben mehr als 47 000 Amerikaner an einer Überdosis von Opioiden, und die Letalität ist auch in den Folgejahren auf einem hohen Niveau, da der Konsum synthetischer Opioide (z. B. Fentanyl-Derivate) in den letzten 5 Jahren erheblich zugenommen hat. Zur Bewältigung der Krise wurden mehrere Maßnahmen vorgeschlagen, darunter Programme zur Überwachung verschreibungspflichtiger Medikamente, Missbrauchs-verhindernde Opioid-Formulierungen, kognitive verhaltenstherapeutische und medikamentengestützte Ansätze und die Verteilung von Naloxon zur Behandlung von Opioid-Überdosierungen – mit bisher eher begrenztem Erfolg. Im Vergleich dazu gab es in mehreren Ländern Europas im letzten Jahrzehnt einen Anstieg der Verschreibungen von Opioiden. Die Letalität durch Opioide ist jedoch deutlich geringer als in den USA. Gründe für diese Unterschiede können auf unterschiedliche Zulassungen, Verschreibungsregeln (z. B. Deutsche Leitlinien zur LONTS, Update 2019) und bessere Implementierung von Qualitätsmaßnahmen zurückzuführen sein. In den USA erleichtert die Konzentration auf die medikamentöse Behandlung von Schmerzen anstatt der Therapie von psychosozialem Stress die Verschreibung von Opioiden. Außerdem ist MAT/OAT (medikamentös- oder opioidgestützte Substitutionstherapie) in vielen europäischen Ländern, insbesondere in ländlichen Gebieten, möglicherweise häufiger und umfassender verfügbar als in den USA.

Abstract

Opioid abuse and overdose deaths are at crisis levels in the USA. More than 47,000 Americans died of drug overdoses involving opioids in 2017 and lethality continues to stay on a high level, because synthetic opioid (e. g. fentanyl derivates) use has increased significantly during the last 5 years. Several measures have been proposed to tackle the crisis including prescription drug monitoring programs, abuse-deterrent opioid formulations, cognitive behavioral and medication-assisted therapies, and naloxone distribution to treat opioid overdose, with limited success. In comparison, several countries in Europe had an increase in opioid prescription during the last decade. However, lethality due to opioids is significantly lower than in the USA. Reasons for these differences may be due to different marketing permits, prescription rules (e. g. German Guidelines on LONTS long term opioid use in non-tumor pain, update 2019) and better results in quality measures. In the US focus on pain rather than treatment of psychosocial stress facilitate opiod prescription. Finally, MAT/OAT (medication or opioid assisted treatment) may be more frequently and comprehensively available in many European countries compared to the US, in particular in rural areas.

Schlüsselwörter

Opioid-Krise USA, - MAT (Medikamenten-Assistierte Therapie, - Substitutionstherapie), KVT (kognitive Verhaltenstherapie) Fentanylderivate - Drogenüberwachungsprogramme, Missbrauchs-abschreckende Opioid-Formulierungen - Naloxon - LONTS-Leitlinien

Key words

opioid crisis USA, MAT, CBT - fentanyl - Drug monitoring programs, abuse deterrent opioid formulations - Naloxone - LONTS guidelines
 

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