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DOI: 10.1055/s-0030-1261910
© Georg Thieme Verlag KG Stuttgart · New York
Substanzabhängigkeit vom Opioidtyp – Behandlung mit oralen retardierten Morphinen
Opioid Dependence – Treatment with Oral Slow Release MorphinePublication History
Publication Date:
11 August 2010 (online)
![](https://www.thieme-connect.de/media/suchttherapie/201003/lookinside/thumbnails/10.1055-s-0030-1261910-1.jpg)
Zusammenfassung
Betrachtet man den chronischen Charakter der Opioidabhängigkeit und die enttäuschenden Behandlungsergebnisse bei kurzfristigen Interventionen wie schnellem Herabdosieren der Erhaltungsmedikation oder Detoxifikationsbehandlungen, so stellt die orale Erhaltungstherapie mit synthetischen Opioiden bei opioidabhängigen Patientinnen und Patienten das Behandlungsregime mit dem besten Therapie-Outcome dar. So wie in allen Bereichen der Medizin, kam es auch in der psychopharmakologischen Behandlung im Rahmen der Diagnose Substanzabhängigkeit vom Morphintyp in den letzten Jahren zu einer Diversifikation. Galt Methadon früher als alleinige State-of-the-Art-Therapie für opioidabhängige Patientinnen und Patienten, so gibt es heute eine größere Auswahl an Medikamenten, die für die Behandlung dieser Patientinnen- und Patientenpopulation geeignet und zugelassen sind. Beispielsweise werden in Österreich orale retardierte Morphine seit dem Jahre 1998 zur Behandlung der Opioidabhängigkeit verwendet – 1999 kam in weiterer Folge auch die Zulassung für Buprenorphin, einem synthetischen Opioid mit gemischter Rezeptoraffinität, hinzu. Obwohl nur in wenigen Ländern orale retardierte Morphine in dieser Indikation zugelassen sind, nicht zuletzt durch das Nicht-Vorliegen umfassender multizentrischer Studien und die Gefahr des erhöhten intravenösen Missbrauchspotenzials, hat sich diese Therapieoption bei begleitender psychosozialer Unterstützung als gute Alternative zur Behandlung mit Methadon oder Buprenorphin etabliert. Hervorgehoben muss allerdings werden, dass diese Medikamente einer gleichermaßen sorgfältigen ärztlichen Verschreibung bedürfen und weitere konfirmative Forschungsergebnisse notwendig sind.
Abstract
Regarding the chronic relapsing nature of opioid dependence and the generally disappointing results of short term options like rapid dose-tapering or detoxification treatment, opioid maintenance therapy seems to be the most effective intervention for this population group. Regarding the fact that development in all fields of medicine took place during the last years, diversification of treatment regarding opioid dependence is also evident. As in most countries methadone has been the only first choice agonist for treatment of this condition for many years, today several other synthetic opioids are approved for treatment of opioid dependence. In Austria, for example, oral slow release morphine is used for opioid maintenance therapy since 1998 and buprenorphine, a partial opioid-agonist, was approved in 1999 for this diagnosis. Despite the fact that for this indication oral slow release morphine is only approved in few countries – because of the lack of multicenter studies dealing with this topic and regarding the increased danger of abusing this substance intravenously – this treatment option including concomitant psychosocial support has been established as a recommendable alternative solution to methadone or buprenorphine. It has to be highlighted that treatment with oral slow release morphine should be accurately prescribed by physicians and further evidence-based scientific research is needed.
Schlüsselwörter
Opioidabhängigkeit - Opioiderhaltungstherapie - orale retardierte Morphine
Key words
opioid dependence - opioid maintenance therapy - oral slow release morphine
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Korrespondenzadresse
Dr. A. Bäwert
Medizinische Universität Wien
Universitätsklinik für Psychiatrie und Psychotherapie
Währinger Gürtel 18–20
1090 Wien
Österreich
Email: andjela.baewert@meduniwien.ac.at