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DOI: 10.1055/s-2003-38097
Illegale Opiatsucht, Behandlung und ökonomische Kostenforschung - ein beispielhafter Überblick und eine Diskussion aus sozialwissenschaftlicher Perspektive
Illicit Opiate Addiction, Treatment and Economic Cost Research - an Exemplary Overview and Discussion from Social Science PerspectivePublication History
Publication Date:
20 March 2003 (online)
Zusammenfassung
Kostenforschung ist sowohl im breiten Gesundheits- als auch im Suchtbereich in den letzten Jahren eine wichtige Perspektive geworden. Im illegalen Drogenbereich bietet sich aus sozialwissenschaftlicher Warte ein beispielhafter Überblick zum Stand und Beitrag der Kostenforschung für das Phänomen der Opiatsucht und ihrer Behandlung an. Aus einer Forschungsperiode von fast dreißig Jahren geht konsequent und klar hervor, dass der Großteil der durch illegale Opiatsucht bedingten sozialen Kosten mit Kriminalität bzw. der Strafverfolgung zusammenhängt. Im Behandlungsfeld wird dagegen gezeigt, dass die vorherrschenden Opiatbehandlungsmodi - vor allem Substitutionsbehandlung - positive Kosten-Nutzen-Effekte erzielen. Die komplexe Herausforderung scheint nun aber die Bedeutung und Anwendung dieser scheinbar klaren Wissensstände und ihrer Determinanten auf die Praxis der Opiatkontroll- oder Behandlungspolitik zu sein. Bisher dokumentierte Kostendynamiken in der Opiatsucht und ihrer Behandlung kämpfen mit dem Problem, dass sie a) in einem sozial konstruierten Umfeld der Illegalität wirken, b) aus spezifischen Forschungsperspektiven hervorgehen und daher nicht auf Allgemeinpopulationen generalisierbar sind und c) in ihrer gegenwärtigen Form wenig zum Bau eines optimierten Behandlungssystems beitragen.
Abstract
Cost research has become an important perspective in recent years, both in the general health as well as the substance use area. In the field of illegal drugs, an exemplary overview will be provided on the status and contribution of cost research on the topic of illicit opiate addiction and its treatment. From a research tradition spanning almost thirty years emerges the consistent and clear knowledge that the lion share of social costs associated with illicit opiate use relates to criminality or the various levels of criminal justice. In the field of treatment it is consistently shown that the predominant modes of treatment - primarily substitution therapy - produce positive cost-benefit ratios. The most difficult challenge, however, seems to be the interpretation and application of these seemingly clear states of knowledge and their determinants to the practices of opiate policy and treatment. The documentation of the cost dynamics for illicit opiate addiction and its treatment up to this point battles with the issues that: a) they take effect in a socially constructed environment of illegality; b) they emerge on the basis of specific and narrow research perspectives and thus are not generalizable to naturally given populations; and c) in their current form contribute little to the building of an optimised intervention system.
Schlüsselwörter
Opiatsucht - Substitutionsbehandlung - Kostenstudien - Drogenpolitik
Key words
Opiate addiction - substitution treatment - cost studies - drug policy
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1 Die in den einzelnen Studien genannten Kostenfelder wurden vom Autor nach bestmöglicher Einschätzung harmonisiert und rekategorisiert und sind so in Tab. 1 dargestellt; Kostenproportionen sind ebenfalls vom Autor selbst berechnet.
Benedikt Fischer, PhD
CAMH/ARF-2035
33 Russell St.
Toronto, Ont.
M5S 2S1
Kanada
Email: Benedikt.Fischer@Utoronto.ca