What means "best practice" in addiction treatment?

The concept of best treatment practice is a response to the growing diversity of therapeutic experience and to the frequently inadequacy of service reality and guidelines. Ideally, best practice guidelines are based on the available research evidence about effi cacy and effectiveness of therapeutic approaches. But limitations of outcome research must be taken into consideration as well as limitations of guideline applicability. Circumstantial factors are also relevant for treatment outcomes, and clinicians are expected to adapt evidence-based recommendations to such factors in their daily practice with individual patients. In addition, availability and access to recommended treatments are in the responsibility of service planners and providers, thereby facilitating the implementation of best practices. We understand best practice not as treatment provided in some centres of excellence, but as a system providing all those in need of treatment in the best possible way. Finally, major changes are expected for the future, redirecting the focus from a traditional evaluation of clinical usefulness for populations to an assessment of individually optimised interventions (personalised medicine: 'treating the patient, not the disease')

¿Qué significa "mejores prácticas" en el tratamiento de las toxicomanías?

El concepto de las mejores prácticas en el tratamiento constituye una respuesta al aumento de la diversidad de las experiencias terapéuticas y a la frecuente insufi ciencia de la realidad y de las directrices de la asistencia. De forma ideal, las directrices de prácticas recomendables se fundamentan en los resultados disponibles de la investigación de la efi cacia y la efectividad de los enfoques terapéuticos. Sin embargo, es esencial tener en cuenta las limitaciones de la evaluación de resultados así como las limitaciones de la aplicabilidad de las directrices. Los factores circunstanciales también son relevantes en los resultados del tratamiento y se espera que los terapeutas clínicos adapten las recomendaciones fundamentadas en pruebas científi cas a dichos factores en su trato diario con los pacientes. Además, la disponibilidad y el acceso a los tratamientos recomendados son responsabilidad de los planifi cadores y proveedores de servicios, facilitando de este modo la implantación de las mejores prácticas. Consideramos que el término 'mejores prácticas' no signifi ca la asistencia proporcionada en ciertos centros de excelencia, sino el sistema que facilita la mejor asistencia posible a todos los que necesitan tratamiento. Por último, se esperan cambios importantes en el futuro, para reorientar el enfoque desde la evaluación tradicional de la utilidad clínica para las poblaciones hacia una evaluación de las intervenciones optimizadas individualmente (medicina personalizada: 'tratando al paciente, no la enfermedad')

Detection and treatment of HIV and hepatitis virus infections in Swiss correctional facilities

Summary: Objectives:: The aim of the study was to obtain an overview on diagnostic and therapeutic activities concerning hepatitis A, B, C virus and HIV in Swiss prisons. Methods:: A standardized questionnaire was sent to 91 prisons in the German and Italian speaking parts in October 2004; 41 institutions (45%) answered the questionnaire. Results:: In almost all prisons serological examinations were not done routinely, but were provided when demanded by inmates or recommended by the medical service. Vaccination against hepatitis A or B infection and initiation of antiviral therapy was possible in most institutions. Conclusions:: Most of the prisons investigated offered diagnostic and antiviral treatment for hepatitis virus and HIV infections. A reported problem was the discontinuation of ongoing treatments or vaccination cycles after discharge. In some cases deficient funding was an obstacl

Prevalence of hepatitis and HIV infections and vaccination rates in patients entering the heroin-assisted treatment in Switzerland between 1994 and 2002

Background::  Hepatitis C virus (HCV) remains very prevalent in injection drug users (IDUs). In spite of recommended vaccinations against hepatitis A virus (HAV) and hepatitis B virus (HBV), many IDUs remain susceptible to HAV and HBV. Study population and methods::  Patients entering heroin-assisted treatment between 2000 and 2002 (N=210) were compared for infectious disease status with patients entering this treatment in 1998 (N=243) and between 1994 and 1996 (N=1035). Infection status was determined with the aid of questionnaires and blood tests for antibodies against HAV, HBV core antigen, HCV and HIV. Results::  In the cohort 2000-2002 78.3% of the patients were HCV positive, 53.3% were HBV positive, 41.2% were HAV positive and 12.6% were HIV positive. In comparison to the cohorts entering the heroin- assisted treatment at an earlier time, there was a significant reduction of HBV and HAV infections, but not of HCV and HIV infections. 15.6% of the patients entering between 2000 and 2002 were vaccinated against HBV and 10.3% against HAV. 31.1% of patients at entrance were susceptible for HBV and 48.5% for HAV. In comparison to patients entering treatment in 1998 there was no significant increase in patients who were vaccinated against HBV. Conclusions:: This data illustrates the need for improving HCV prevention and more consequent vaccination against HBV and HAV in IDU

Development of a monitoring system for heroin-assisted substitution treatment in Switzerland

Summary: Objectives: Switzerland introduced heroin-assisted treatment as a routine treatment for drug addicts. As a result the evaluation instruments were changed from a detailed scientific project to a routine monitoring system. The process for developing this monitoring system is described. Methods: The questionnaires and assessment instruments were restyled with staff of the treatment agencies. Indicators measuring quality of treatment and measures from the future national statistic on the addiction support system were integrated into admission, course and discharge questionnaires. Currently a system for feedback to treatment agencies is being developed. Results: All 21 treatment agencies are participating in the monitoring. Assessment quality is high. Conclusions: The described monitoring should provide continuous delivery of basic relevant data on patient

Detection and treatment of HIV and hepatitis virus infections in Swiss correctional facilities

OBJECTIVES: The aim of the study was to obtain an overview on diagnostic and therapeutic activities concerning hepatitis A, B, C virus and HIV in Swiss prisons.METHODS: A standardized questionnaire was sent to 91 prisons in the German and Italian speaking parts in October 2004; 41 institutions (45%) answered the questionnaire.RESULTS: In almost all prisons serological examinations were not done routinely, but were provided when demanded by inmates or recommended by the medical service. Vaccination against hepatitis A or B infection and initiation of antiviral therapy was possible in most institutions.CONCLUSIONS: Most of the prisons investigated offered diagnostic and antiviral treatment for hepatitis virus and HIV infections. A reported problem was the discontinuation of ongoing treatments or vaccination cycles after discharge. In some cases deficient funding was an obstacle

Two decades of the Swiss program based on the prescription of Diacetylmorphine, from a public health intervention to a treatment option

The medical prescription of diacetyl morphine (heroin) treatment is an addition to the therapeutic arsenal for patients gravely dependent or addicted to heroin use and for whom other forms of therapy have failed. In Switzerland, the Federal Office of Public Health SFOPH) has established directives and recommendations concerning prescription and administration of diacetyl- morphine

Cannabis 2008. Update zum Cannabisbericht 1999

Die Eidgenössische Kommission für Drogenfragen (EKDF) hat im Jahre 1999 einen «Cannabisbericht» veröffentlicht. Zur Überprüfung der damals formulierten Empfehlungen hat sie im Sommer 2007 eine Studie in Auftrag gegeben, die seither publizierte wissenschaftliche Literatur zu sichten. Im Vordergrund stand dabei die Frage, ob sich die Gefährdung durch den Konsum von Cannabis für die Konsumierenden wie auch für die Bevölkerung seit 1999 verändert hat