Die „Opiate Dosage Adequacy Scale“ (ODAS) für die Beurteilung der Angemessenheit der Bupren­orphindosierung während der Opiatsubstitution

Zusammenfassung

Kontext:

Buprenorphin ist in Deutschland seit dem Jahr 2000 für die Substitutionsbehandlung Opiatabhängiger zugelassen und wird derzeit bei knapp einem Fünftel aller substituierten Patienten eingesetzt. Studien belegen die Wirksamkeit von Buprenorphin in der Opiatsubstitution. Ähnlich anderer Substitute führen höhere Dosierungen mit Buprenorphin vermehrt zu einer erhöhten Retention und reduziertem Beigebrauch weiterer psychotroper Substanzen, wohingegen ein Teil der Patienten bereits von niedrigen bis mittleren Dosen profitiert. Entscheidend ist somit nicht per se die Höhe der Dosierung, sondern deren Angemessenheit, ausgerichtet an den individuellen Bedürfnissen des Patienten. Zu diesem Zweck wurde die „Opiate Dosage Adequacy Scale“ (ODAS) entwickelt, die bislang nur für das Substitut Methadon vorlag.

Ziel:

Erstellung einer deutschsprachigen Ver­sion der „Opiate Dosage Adequacy Scale“ (ODAS) für Buprenorphin.

Methode:

Die Anpassung des ODAS-Fragebogens durch eine Expertengruppe erfolgte sprachlich auf Basis der deutschen Skala für Methadon. Gleichzeitig wurde der Fragenalgorithmus geprüft und zur besseren Verständlichkeit und Anwendbarkeit angepasst.

Ergebnis und Diskussion:

Nach der sprachlichen Anpassung liegt die „Opiate Dosage Adequacy Scale“ (ODAS) nun erstmals auch für Buprenorphin vor. Nach erfolgreicher Validierung in einer Anwendungsstudie könnte sich der ODAS-Fragebogen als ein ausgezeichnetes Instrument für die Qualitätssicherung in der Opiatsubstitu­tion mit Buprenorphin erweisen.

Abstract

Context:

In Germany, Buprenorphine is approved for the treatment of chronic opiate dependence since 2000. Currently, one fifth of all pa­tients in opiate substitution treatment (OST) are receiving buprenorphine. The effectiveness of buprenorphine is well documented. Comparable to other OST medications higher dosages of buprenorphine lead to higher retention rates and a reduction in the use of other illicit substances. However, some patients already benefit from low or middle dosages. Given this, the dosage of the OST medication itself is not a stand-alone predictor for the success of OST. Moreover, the adequacy of the dosage aligned according to the individual needs of patients is relevant. For this purpose the “Opiate Dosage Adequacy Scale” (ODAS) was developed, which was so far only available for methadone.

Aim:

Development of a German version of the ODAS for buprenorphine.

Method:

An expert group adjusted the German ODAS for methadone on a linguistic basis. Simultaneously, the query algorithm was customized for an improved intelligibility and applicability.

Results and discussion:

After the linguistic adjustment, a German version of the “Opiate Dosage Adequacy Scale” (ODAS) is now available for buprenorphine. Under the prerequisite of a successful validation the ODAS could be a suitable quality assurance instrument for OST with ­buprenorphine.

Schlüsselwörter

Opiatsubstitution - Buprenorphin - adäquate Dosierung

Key words

opiate substitution treatment - buprenorphine - dosage

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