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Arch Hellen Med, 31(Supplement 1), 2014, 43-51


Widening access to opioid dependence treatment services through integration of primary care.
Αn externally imposed directive or a conscious system choice?

K. Souliotis,1,2 C. Golna,3,4 M. Malliori,5 X. Contiades,1 E. Thiraios,6,7 C. Lionis8
1Department of Social and Educational Policy, Faculty of Social Sciences, University of Peloponnese, Corinth,
2Center for Health Services Research, Department of Hygiene, Epidemiology & Medical Statistics, Medical School, University of Athens, Athens,
3Department of Hygiene, Epidemiology & Medical Statistics at Athens University Medical School, Athens,
4Hepatitis B and C Public Policy Association,
51st Department of Psychiatry, Medical School, University of Athens, Athens,
6Athens Medical Society, Athens,
7Vari Health Centre, Vari,
8Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece

The effectiveness of policies to address and manage opioid dependence is pursuant to the active participation of society and its institutions to policy design and implementation, which in turn depends on societal understanding and acceptance. As such, policy design should focus on producing and implementing measures and interventions that are embedded in evidenced based best practices, leverage optimally available human and financial resources and aim at the normalization of opioid dependence management in the health care system. In times when the economic crisis results in severe cuts in all levels of public spending, global coverage is highly dependent on the selection of a service provision structure that not only appears optimal but is also evidence based and can thus be politically legitimized, financially supported and socially accepted. The externally formulated "directive" of widening access to opioid dependence pharmacologically assisted treatment in Greece through the integration of primary care services finds solid ground in arguments (and evidence) of optimal resource allocation, improvements in patient quality of life and minimization of social stigma. It is also in line with the definition and understanding of opioid dependence as a mental health disorder, the management of which should be integrated with general health services. For these reasons, in Greece, such a directive should also constitute a conscious political choice, as it could guarantee the ongoing sustainability of treatment programs and the systematically adequate coverage of treatment demand in times of scarce resources. This would, in turn, be subject to certain, critical prerequisites being met, such as: the careful selection of structures and services that could participate in such an expansion, the adequate and ongoing training of health professionals at both specialist and generalist level and the integrated management of opioid dependence, independent of type of structure and geography, to the benefit of the patient and society as a whole.

Key words: Cost effectiveness, Generalist and specialist training, Integrated opioid dependence management, Primary health care, Stigma.

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