Treatment with Opiate substitutes such as Methadone or L-Polamidon. One differentiates between a continuous therapy ("maintenance") and a withdrawal therapy with Methadone ("maintenance to abstinence").
Therapy goals with the continuous therapy, with which daily 40 to 80 milligram Methadone are given, are above all health stabilization, social integration, prevention of the subsequent criminality and from serious infections such as hepatitis C or AIDS with opiate addicts, with which all drug-free therapies failed. Methadone withdrawal therapy with slowly decreasing dosage is also recommended particularly with addicted pregnant women and their likewise heroin-dependent newborn children. While American and English follow-up studies (e.g. F.R.Gearing, 1974) reported on successes of the continuous therapy, the substitution treatment with Methadone was accomplished in Germany until 1990 only in particularly justified individual cases. Methadone or l-Polamidon was taken across a longer period, which can lead even to a physical dependence and withdrawal symptoms when setting off.
With the NUB guidelines (new treatment guidelines of the federal committee of the physicians and health insurance companies on 1 October 1991, who regulate the treatment of heroin-dependent with Methadone (and/or Levo Methadone), the substitution treatment in the following cases became possible:
- with life-threatening conditions in the withdrawal, when heavy consuming illnesses,
- with opioid obligating pain conditions,
- during the pregnancy as well as bypass treatment.
In the last years in Great Britain and Switzerland attempts with legal heroin using up for opiate dependent people completely become impoverished are particularly accomplished (so-called harm reduction).
Past evaluations of Methadone projects in different countries of the Federal Republic of Germany refer to the meaning of a simultaneous psychosocial support beside the pure Methadone cure. Since 1,7,2002 the substitution may take place only via physicians with appropriate auxiliary qualification (§ 5 BtMVV). A countrywide substitution register is in the structure (&ect; 5a BtMVV). As the further "substitution medicine" starting from 1976 particularly of opiate addicts themselves the medicine Valorone (active substance: Tilidine) as substitution means and/or to the decrease of the withdrawal became used. Up to the regulation of the Methadone prescription by physicians practicing medicine freely occasional Dihydrocodein for ambulatory withdrawal was used up.
