Attitudes and beliefs of doctors prescribing methadone to addicts in the Westfalen-Lippe region of Germany

[Treatment of Opioid-dependent Inmates - Attitudes and Treatment Practice of medical Staff in Bavarian Prisons]

BACKGROUND

The present study examines the treatment practice and attitudes of medical staff towards opioid-dependent inmates in Bavarian prisons.

METHOD

We interviewed medical staff (n=20) from 18 Bavarian prisons about substitution practice and attitudes by semi-structured interviews.

RESULTS

With regard to the treatment routines and the attitudes of the medical staff, we found mixed results. From the perspective of the medical staff, the treatment decision depends on the patients' wishes, the severity and duration of the dependence, the length of sentence and organizational factors. Problems were discussed in particular with regard to the care situation inside and outside the prisons and difficulties in transition management.

CONCLUSIONS

Substitution therapy is considered a standard treatment method in prisons today. However, our respondents highlighted some disadvantages (e. g. passing on the substitution drug). Although the treatment goal of complete abstinence was generally viewed positively by a part of the medical staff, it was not considered very realistic. From the point of view of the respondents, special attention should be paid to the continuity of the chosen treatment strategy in the context of discharge management.

Drug-Substitution Treatment in Germany: A Critical Overview of Its History, Legislation and Current Practice

Within a global context, Germany was relatively late in its acceptance of substitution treatment, having first introduced methadone maintenance treatment (MMT) in the late 1980s. Since the early 1990s, Germany has taken a number of legal steps which favor harm reduction, assistance and treatment, rather than the law enforcement approach that was dominant before. As a result of this new commitment, Germany now also allows the use of non-methadone substitutes, such as buprenorphine, LAAM, dihydrocodeine (DHC) and codeine. A heroin maintenance trial has been scheduled to begin in early 2002. Despite the fact that the overall number of participants in drug-substitution treatment has risen over the past decade from about 1,000 in the early 1990s to more than 55,000 in 2001 and that MMT has been comprehensively evaluated in Germany with favorable outcomes, there remains a lack of availability of and accessibility to substitution treatment, due to rigid entry and treatment criteria imposed by the social health insurers (SHI).

Are methadone counselors properly equipped to meet the palliative care needs of older adults in methadone maintenance treatment? Implications for training

Today's methadone patients differ greatly from those of the past. Because of the rise of polydrug use and the HIV and hepatitis epidemics, treatment has become much more complex, which multiply the concerns and complexities of treatment. Patients entering methadone programs are also more commonly presenting at ages well into their 50s, 60s, and 70s; and this phenomenon of high rates continues to grow. The majority of these individuals in treatment have presented with a number of significant comorbid medical conditions that will progress and eventually lead to death. This aging cohort must be approached with a modified treatment plan that focuses on management and promoting healthy aging, while attending to their maximum delay of illness, disease, and disability. This article argues that it is necessary for counselors working with this group to adopt a palliative care philosophy. This article also makes recommendations in areas that counselors need to be knowledgeable and skilled in to provide appropriate palliative services specific to this aging population with multiple needs as they near end of life.

The science and practice of medication-assisted treatments for opioid dependence

This paper briefly reviews the evolution of opioid addiction treatment from humanitarian to scientific and evidence-based, the evidence bases supporting major medication-assisted treatments and adjunctive psychosocial techniques, as well as challenges faced by clinicians and treatment providers seeking to provide those treatments. Attitudes, politics, policy, and financial issues are discussed.

Abstinence orientation and treatment practice: an analysis of German settings providing opioid maintenance therapy

We examined whether differences in abstinence orientation are related to differences in treatment patterns by analyzing assessment data from a total of 161 German treatment settings offering opioid maintenance therapy. According to an index value, settings were divided into low (LAOs), medium (MAOs), and high abstinence-oriented settings (HAOs). Logistic, multinomial logistic, and linear regression analyses were carried out. HAOs prescribed lower maximum dosages of methadone and enforced rules for handling of concomitant drug use more rigidly than MAOs and LAOs. Patients in HAOs were more likely to undergo psychotherapeutic and psychiatric treatment than in MAOs and LAOs. Limitations, conclusions, and future research are suggested.

Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations

Background

Research questionnaires are not always translated appropriately before they are used in new temporal, cultural or linguistic settings. The results based on such instruments may therefore not accurately reflect what they are supposed to measure. This paper aims to illustrate the process and required steps involved in the cross-cultural adaptation of a research instrument using the adaptation process of an attitudinal instrument as an example.

Methods

A questionnaire was needed for the implementation of a study in Norway 2007. There was no appropriate instruments available in Norwegian, thus an Australian-English instrument was cross-culturally adapted.

Results

The adaptation process included investigation of conceptual and item equivalence. Two forward and two back-translations were synthesized and compared by an expert committee. Thereafter the instrument was pretested and adjusted accordingly. The final questionnaire was administered to opioid maintenance treatment staff (n=140) and harm reduction staff (n=180). The overall response rate was 84%. The original instrument failed confirmatory analysis. Instead a new two-factor scale was identified and found valid in the new setting.

Conclusions

The failure of the original scale highlights the importance of adapting instruments to current research settings. It also emphasizes the importance of ensuring that concepts within an instrument are equal between the original and target language, time and context. If the described stages in the cross-cultural adaptation process had been omitted, the findings would have been misleading, even if presented with apparent precision. Thus, it is important to consider possible barriers when making a direct comparison between different nations, cultures and times.

Knowledge and Attitudes About Methadone Maintenance Among Staff Working in a Therapeutic Community

Research demonstrates that drug treatment staff members' knowledge and attitudes about methadone are positively correlated with treatment success among opiate-dependent clients. However the bulk of this research is on outpatient treatment in methadone clinics. This study examined a residential treatment program that allowed clients on methadone, a rare treatment opportunity that is growing nationwide. Staff (N = 87) working in four therapeutic community (TC) facilities, were surveyed using the Abstinence Orientation Scale (AOS), Methadone Knowledge Scale (MKS), and Disapproval of Drug Use Scale (DDU). The relationships between TC staff characteristics and scores on the assessment measures were tested for differences. Staff members who affirmed having been in treatment had greater methadone knowledge than those who had not. Staff members who participated in methadone sensitivity training had greater methadone knowledge and lower abstinence orientation than those who did not attend the training. Staff in this study had stronger abstinence orientation than found in studies of methadone clinic staff, which may represent a barrier to methadone in residential settings. This study suggests that staff experience is correlated with attitudes and knowledge about methadone and that staff training is associated with changing attitudes and knowledge about methadone.

Comparison of drug abuse in Germany and China

Drug abuse has a long, but also different history in Germany and China. The Opium War largely influenced the history of China in 19th century; however, China was once recognized as a drug-free nation for 3 decades from the 1950s to the 1980s. Drug abuse has spread quickly since re-emerging as a national problem in China in the late 1980s. The number of registered drug abusers increased from 70 000 in 1990 to more than 1 million by the end of 2005. In past decades, illicit drug trafficking and production have swept most provinces in China, and drug abuse has caused many problems for both abusers and the community. One major drug-related problem is the spread of HIV, which has caused major social and economic damage in China. Germany, the largest developed European country, also faces the drug and addiction problem. Germany has about 150 000 heroin addicts, for whom HIV/AIDS has become a serious threat since the mid 1980s. To control the drug problem, the German Government adopted the “Action Plan on Drugs and Addiction” in 2003; the China Central Government approved a similar regulation in the antidrug campaign in 2005. Germany has experience in reducing drug-related harm. The methadone maintenance treatment (MMT) program has run for more than 20 years and the public has become more tolerant of addicts. In 2003, China began the MMT program for controlling the spread of HIV/AIDS. It is necessary for China to learn from developed countries to acquire success in its antidrug campaign. In this review, we will go over the differences and similarities in drug abuse between Germany and China. The differences are related to history, population and economics, drug policy context, drug laws, HIV/hepatitis C virus infection, the MMT program and so on. These 2 nations have drug abuse problems with different histories and currently use different approaches to handle illicit drug marketing and use. The legal penalties for illicit drug offences reflect the social differences of these 2 nations with respect to the seriousness of particular types of crimes. The characteristics of the MMT program may also influence patterns of drug abuse in these 2 nations and China should improve the MMT program based on the successful model in Europe, the USA, and Australia. We recommend more dialogue and collaboration between Germany and China.