The best treatments for opioid addiction is opioid agonist therapy (OAT). For most addiction patients, the goal of therapy is stabilization on a social and health level. This is usually achieved with OAT, as Prof. Dr. Philip Bruggmann, co-chief physician of internal medicine, Arud Center for Addiction Medicine Zurich, explained in a lecture at the FomF General Internal Medicine Update Refresher.
A cookbook approach is not possible with opioid agonist therapy (OAT), because not everyone metabolizes opioids in the same way. People who break down these substances quickly need a higher dose than those who metabolize them slowly. The dose also depends on living conditions and stress.https://youtu.be/-RF9vg5tbpo?si=Rb-RnpQRbIsw-ctM
“Traditionally, patients need a smaller dose when they are on vacation,” said Prof. Bruggmann. Because not every opioid has the same effect on everyone, the substances in OAT cannot be swapped around at will.
Diacetylmorphine most prescribed substance
The most common substance prescribed for OAT at the Zurich Center for Addiction Medicine Arud is diacetylmorphine, the prescribed heroin. The drug can be administered intravenously, orally or, more recently, nasally. Since the corona pandemic, certified centers have been allowed to give patients diacetylmorphine for a week at a time. This practice enables opioid addicts to lead a normal life again. “In Zurich, we now care for a number of patients on diacetylmorphine who are well integrated, have responsible jobs and even have families,” says Prof. Bruggmann.
The second most commonly prescribed substance for OAT is sustained-release morphine. Methadone comes in third place, and buprenorphine is the last. The decision for a substance is made together with the patient. “Opioid addicts know best what they need so that they do not consume other substances and can function as well as possible in everyday life,” explained the addiction medicine specialist