Archives of Hellenic Medicine

Last update:

09-Sep-2014

Arch Hellen Med, 31(Supplement 1), 2014, 25-34

SPECIAL ARTICLE

Alternative systems for the provision of pharmacologically assisted treatment of opioid dependence:
from strict control to care in the community and Primary Health Care

C. Golna,^1,2 M. Malliori,³ M. Tsironi,⁴ K. Souliotis,^4,5 C. Lionis⁶
¹Department of Hygiene, Epidemiology & Medical Statistics at Athens University Medical School, Athens, Greece,
²Hepatitis B and C Public Policy Association,
³1st Department of Psychiatry, Athens University Medical School, Athens,
⁴Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta,
⁵Center for Health Services Research, Department of Hygiene, Epidemiology & Medical Statistics, Athens University Medical School, Athens,
⁶Department of Social and Educational Policy, Faculty of Social and Political Sciences, University of Peloponnese, Corinth,
⁷Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece

According to the World Health Organization (WHO), the term «treatment» refers to a process, which commences when a patient contacts a health professional or a community service and which is maintained and further diversified until this patient attains the highest possible (personal) level of health and wellbeing. Opioid dependence treatment is defined as a programme or intervention that is targeted directly to persons dependent on opioids and is aimed at keeping them alive, improving their psychological, physical and social conditions and helping them manage their dependence through to recovery. The WHO defines pharmacologically assisted treatment, as such a treatment process, also assisted by the provision of opioid antagonist medications (also known as opioid substitution treatment - OST). This paper discusses alternative system structures for the provision of opioid dependence pharmacologically assisted treatment and evaluates these as to their accessibility, cost effectiveness and level of social stigma. Overall, the evaluation of alternative treatment structures confirms that, treatment provision in the primary care setting is not only recommended by the WHO and most international organizations but also feasible in practice. A wealth of studies confirm the importance of treatment availability in the primary care setting and the benefits it results in both for the person being treated and for the society as a whole. These studies also underline the importance of ongoing specialized (technical and non-technical) training and support for primary care health professionals to ensure integrated care is provided to persons dependent on opioids.

Key words: Accessibility, Availability, Equity in access, Cost effectiveness, Institutionalized setting, Opioid dependence treatment, Primary care setting, Social stigma, System structure, Treatment in the community.