Ambros Uchtenhagen

• M.D., Ph.D.
• Chair at University of Zurich

Substance dependence is recognized in the scientific community to be a medical condition rather than a willful misbehavior, but in societies and in politics a connotation of moral weakness, of irresponsible behavior or even of criminal intent can be observed, in attitudes and arguments and in a stigmatization of addictive behavior. Therefore, treat...

Objective To review the scientific literature on the pharmacokinetics, pharmacodynamics and clinical efficacy and safety of (supervised) oral diacetylmorphine for patients with severe heroin dependence. Methods The PubMed, Embase, Web of Science and PsycINFO databases were searched. Eleven published studies were identified and selected based on de...

Monitoring and evaluation (M & E) are research activities dedicated to document and analyze the processes and outcomes of addiction treatment. Before starting M & E, some conceptual issues apply, such as considering the objectives of a given treatment or treatment system, the outcome indicators to be used, the characteristics of the target populati...

The focus of this section is mainly on the treatment system and on the community, at a regional or national level, as a comprehensive network of different approaches, services, and actors, covering all types of addictive behaviors. This implies the preference for a public health perspective, combining the care for the individual patients in their d...

The United Nations (UN) conventions present the international legal framework; they urge member states to provide treatment and rehabilitation but prohibit consumption and possession of scheduled drugs. This creates problems for providing treatment and harm reduction programs to patients who are not or not yet ready to stop illicit drug use. Other...

Stepped care models aim at matching treatment intensity to defined patient characteristics in a systematic way, thereby avoiding misplacements and making best use of available treatment resources at the same time. In principle, treatment planning for new patients starts with the least intensive care, progressing to more intensive regimes for nonres...

Background In the context of the current US opioid crisis and the compelling fact that a quarter to a third of all those addicted to heroin pass through its prisons and jails each year, the care of incarcerated opioid-using individuals (OUI) needs to be improved. Aims Little has been published on the effectiveness or outcomes of heroin-assisted tr...

Schizophrenic patients with a substance abuse condition present one of the highest risks for violent behaviour. The traditional safety measures used in psychiatry are still in force but challenged by a trend to avoid all involuntary action, in respect of patient autonomy. There is an urgent need to develop strategies to cope with this situation, wh...

Ein Grundsatzentscheid des Bundesgerichts stuft Suchtkrankheiten als psychiatrische Krankheiten ein (publiziert als BGE-145-V-215 am 05.08.2019). Damit sind Suchtkrankheiten neu unter bestimmten Voraussetzungen rententauglich. Im Einzelfall muss ein strukturiertes Verfahren zur Abklärung des Leidens und der Arbeitsfähigkeit durchgeführt werden. Dab...

Introduction: Prescribing opium, morphine and heroin to opiate addicts has a long history, as an approach to prevent negative consequences from excessive and uncontrolled use. It rarely reached the majority of this target population. During the 20th century, moral concerns mainly led to control measures and total prohibition (except for medicinal u...

Commentary to: Can new psychoactive substances be regulated effectively? An assessment of the British Psychoactive Substances Bill

Psychotropic substances were used throughout history for medicinal, ritual, and recreational purposes. Overuse may result in pathological consumption styles, mainly dependence and other forms of abuse (hazardous use, harmful use). Attempts at political, religious, and social control of use, including total prohibition of all or specific substances,...

Background/aims: We report on the rates of hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in 1,313 clients entering heroin-assisted treatment (HAT) in Switzerland from 2003 to 2013. We identify predictors of HCV infection. Methods: Data were collected using questionnaires within 2...

Lower-income countries sometimes have difficulties assessing the nature and scope of addiction problems in their countries and in planning the treatment system accordingly. Adapting existing services to changing patterns of substance use disorders and related problems can also be a challenge. This chapter provides a public health approach to the de...

The UN conventions present the international legal framework; they urge member states to provide treatment and rehabilitation but prohibit consumption and possession of scheduled drugs. This creates problems for providing treatment and harm reduction programs to patients who are not or not yet ready to stop illicit drug use. Other international doc...

Stepped care models aim at matching treatment intensity to defined patient characteristics in a systematic way, thereby avoiding misplacements and making best use of available treatment resources at the same time. In principle, treatment planning for new patients starts with the least intensive care, progressing to more intensive regimes for nonres...

Monitoring and evaluation (M & E) are research activities dedicated to document and analyze the processes and outcomes of addiction treatment. Before starting M & E, some conceptual issues apply, such as considering the objectives of a given treatment or treatment system, the outcome indicators to be used, the characteristics of the target populati...

Psychiatric disorders occur frequently in individuals with opiate dependence in epidemiology and in clinical studies. A relief from emotional distress is considered to contribute to these elevated rates. Such an effect may contribute to the attractiveness of opioid maintenance treatment for dual diagnosis patients. Psychiatric disorders risk to be...

Psychotropic substances were used throughout history for medicinal, ritual, and recreational purposes. Overuse may result in pathological consumption styles, mainly dependence and other forms of abuse (hazardous use, harmful use). Attempts at political, religious, and social control of use, including total prohibition of all or specific substances,...

Background Supervised injectable heroin (SIH) treatment has emerged over the past 15 years as an intensive treatment for entrenched heroin users who have not responded to standard treatments such as oral methadone maintenance treatment (MMT) or residential rehabilitation.AimsTo synthesise published findings for treatment with SIH for refractory her...

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 adm...

This book provides a comprehensive, state of the art overview covering both the diagnosis and the treatment of dual disorders – joint psychiatric and substance use disorders – in a way that is highly relevant to clinical work and the organization of care systems. It is designed to meet the real need for a European perspective on dual disorders, tak...

Aims To examine the evidence of association between intimate partner physical or sexual violence (IPV) victimization and alcohol consumption in women. Methods We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies released before 6 June 2013. Studies providing an estimate of association between violence and a...

Aims: The aim of this paper is to illustrate how Switzerland was able to play such a pioneering role in the field of addiction treatment, in creating a drug policy that includes the medical prescription of diacetylmorphine (heroin). The paper will also describe the role of knowledge brokering processes and coalition building in the different phase...

Background/aims: The Study on the Development of an EU Framework for Minimum Quality Standards and Benchmarks in Drug Demand Reduction (EQUS) has set up an inventory of quality standards and initiated a consensus-building process, aiming at establishing a set of European minimum quality standards (MQS) for treatment/rehabilitation and harm reducti...

In den letzten Jahren ist das Thema «Sucht im Alter» besser wahrgenommen und angegangen worden, was sich an vielen Beispielen zeigen lässt. Trotzdem gilt das keineswegs generell; viele relevante Akteure im Alters- und im Suchtbereich haben andere Schwerpunkte. Das vorliegende Heft legt im Unterschied zu den früheren Themenheften den Fokus auf Proje...

Das heutige Schweizer Institut für Sucht- und Gesundheitsforschung ISGF entstand aus einer nationalen und lokalen Krise im Zusammenhang mit dem sprunghaft angestiegenen intravenösen Drogenkonsum und der damit verbundenen Aids-Epidemie. Die Umsetzung einer innovativen Drogenpolitik schuf einen Bedarf an konzeptioneller und evaluativer wissenschaftli...

The treatment of opioid dependence is one of the best researched in the addiction field, and an appropriate mix of therapeutic approaches, including substitution maintenance, is effective in reducing prevalence and the negative health and social consequences. But severe deficiencies in quality and coverage are major causes for missing the full pote...

How to measure outcome in clinical trials of substance abuse treatment The paper of Donovan et al moves from a restrictive title (treatment of illicit drug dependence) to general conclusions about substance abuse treatment outcomes, and from a single common indicator to a range of trial specific measures. The reason for identifying a single indica...

Die Neuerungen der «4-Säulen-Drogenpolitik» stiessen im Ausland zunächst auf Widerstand, fanden aber schrittweise Anerkennung und Nachahmung, insbesondere unter den Stichworten Schadensminderung und diversifizierte Substitutionsbehandlung für Heroinabhängige. Diese Politik wurde zum Mainstream in Europa. Eine ebenso bedeutsame Auswirkung hatten und...

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 efficacy and effectiveness of therapeutic approaches. But limitations of outcome research mus...

Zunehmende Beschaftigung mit Ethik allgemein und in der Medizin insbesondere steht in engem Zusammenhang mit gesellschaftlichen und fachlichen Entwicklungen und hat die Aufgabe von Ethik gescharft. Die Grundlagen fur ethisches Handeln im Suchtbereich sind Menschenrechte und medizinische Ethik. Beide lassen allerdings viel Ermessensspielraum offen f...

Las sociedades organizadas democráticamente están obligadas a encontrar la manera de proceder en caso de necesitar una reformulación de las estrategias frente a los nuevos avances sociales y tecnológicos, especialmente cuando hay preferencias e intereses controvertidos. Los cambios en política de drogas son un ejemplo excelente para discutir el pro...

Maintaining opiate addicts on opiates has a long history. The idea to prescribe pharmaceutical morphine as a substitute for street heroin started in USA and was abolished on the basis of prohibitionist legislation. A new approach to maintain opiate addicts on substitution therapy was initiated in USA in 1963, with the prescription of methadone. Thi...

Policies and practices related to the quasi-compulsory treatment (QCT) of substance-dependent offenders are currently implemented in many countries, despite the absence of reliable knowledge about significant predictors of treatment retention. This study aimed to identify such predictors in QCT and voluntary treatment. Participants were treated in...

Democratically organised societies have to find ways how to proceed when in need of a reformulation of strategies in face of new societal and technological developments, especially in dealing with controversial preferences and interests. The area of drug policy change presents an excellent example for discussing the problem and the process of coali...

Substance dependence is recognized in the scientific community to be a medical condition rather than a willful misbehavior, but in societies and in politics a connotation of moral weakness, of irresponsible behavior or even of criminal intent can be observed, in attitudes and arguments and in a stigmatization of addictive behavior. Therefore, treat...

European policy and practice in caring for people living with addictions is based on defined values (human rights, medical ethics) and on research evidence for the effects and impact of interventions. The focus of the paper is on risk management approaches to reduce the negative consequences of continued illicit drug use, being the ethically most d...

Anliegen Untersuchung des Langzeitverlaufs über 14 Jahre aller Patienten unter heroingestützter Behandlung (HegeBe) in der Schweiz. Methode Analyse des Verbleibs der 3155 in die HegeBe Aufgenommenen mittels Cox-Regression. Ergebnisse Die mediane Behandlungsdauer betrug 11,4 Jahre mit 299 erwünschten Beendigungen und 463 unerwünschten Abbrüchen. Ein...

To assess the long-term course of the feasibility and safety of orally administered heroin [diacetylmorphine (DAM)] tablets in substitution treatment of severely addicted opioid users. Open-label, prospective cohort study with 2 non-randomly assigned treatment arms: DAM tablets only (n = 128) or DAM tablets combined with injected DAM and/or other o...

Ein maßvoller Umgang mit Suchtmitteln ist Bestandteil des Lebensstils einer Mehrzahl von Menschen. Lange Zeit ging die Therapie von Suchtmittelabhängigen davon aus, dass diese das nicht leisten können, und strebte völligen Konsumverzicht an. Es gibt gute Gründe, das in seiner Allgemeingültigkeit in Frage zu stellen; solche Gründe werden anhand von...

To identify prognostic factors for a positive or negative termination of heroin-assisted treatment (HAT) in Switzerland. A complete census of all 3155 patients ever admitted was analysed using the proportional hazard model (including time dependent covariates). Median length of stay was 11.4 years; the maximal length of stay was 13.9 years. 299 pos...

This study evaluates quasi-compulsory drug treatment (QCT) arrangements for substance-dependent offenders receiving treatment instead of imprisonment in comparison to voluntary treatment within five European countries. Participants were interviewed with the European Addiction Severity Index, the ASI-crime module, questions on perception of pressure...

Switzerland introduced a pragmatic national drug policy when the former conservative abstinence-orientated politics proved unable to cope with an escalating number of users and related negative consequences for public health and public order. The high visibility of 'needle parks' and the size of the acquired immune deficiency disorder (AIDS) epidem...

Opioid substitution therapy (OST) in the Ukraine was not provided until 2004. Methadone maintenance therapy only became available in May 2008. Injecting drug users in Ukraine are predominantly injecting self-made opioid solution ('Shirka'). A feasibility study on buprenorphine and methadone maintenance treatment was conducted in 2008. A total of 33...

Opiate substitution therapy (OST) in the Ukraine was not provided until 2004. As part of the introduction of OST, the first feasibility study was conducted in 2007. Six clinics in 6 cities were involved in providing OST and collecting data. A total of 151 opiate-dependent patients were given buprenorphine as a substitute, and a survey of substance...

Der Stellenwert des Abstinenzideals als gesellschaftlicher Leitidee hängt eng zusammen mit dem Bestreben, Suchtmittelkonsum unter Kontrolle zu halten, im Interesse von Ordnungsvorstellungen und wirtschaftlicher Prosperität. Dies hat seit dem Beginn der Neuzeit eine zunehmende Rolle gespielt, im Zuge einer zunehmenden „Rationalisierung der Lebensfüh...

Patients who entered heroin-assisted treatment (HAT) (n = 220) or abstinence-oriented residential treatment (AORT) (n = 982) in Switzerland in 2005/06 were compared. Patients entering HAT were older, spent more time in prison and had more previous treatment attempts, but AORT patients had more often unsafe injections. Self-referrals were more frequ...

Social psychiatry started over a century ago under the auspices of mental and racial hygiene, but after World War II it embraced concepts of community-based care and de-institutionalization. The major psychiatric reforms in the second half of the last century were mainly based on such concepts, including the reforms of Swiss and especially Zurich p...

Evaluation als Instrument zur systematischen und transparenten Bewertung von Projekten, Massnahmen, Programmen, Gesetzen und anderen Gegenständen hat in den letzten zwei Dekaden in Kontinentaleuropa stark an Bedeutung gewonnen. Evaluationstätigkeiten werden auf der Angebots- und Nachfrageseite professionalisiert. Die Gründung entsprechender Fachges...

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. A standardized questionnaire was sent to 91 prisons in the German and Italian speaking parts in October 2004; 41 institutions (45%) answered the questionnaire. In almost all prisons serological examina...

Opioid substitution treatment has been studied extensively in industrialized countries, but there are relatively few studies in developing/transitional countries. The aim of this study was to examine the effectiveness of opioid substitution treatment (OST) in less resourced countries. Longitudinal cohort study. Purposively selected OST sites in Asi...

A multi-country, multi-site comparative research study has documented the feasibility of recruiting drug-dependent individuals receiving treatment as an alternative to imprisonment (‘quasi-compulsory’ treatment, in the setting of an experimental group), while comparing them with those receiving treatment in the same therapeutic institutions, on a v...

Eine gute (präventive, beraterische, therapeutische) Arbeit mit Menschen, die Suchtprobleme haben, geht über eine auf wissenschaftliche Evidenz abgestützte Praxis hinaus, indem sie auch auf situative Faktoren abstellen muss. Die „Güte” einer Praxis bemisst sich an ihren Ergebnissen, also daran wie weit sie die generellen und individuellen Ziele der...

Continued education of professionals is a major factor for service improvement and evidence-based good practice. This project explores the strategies used for this purpose across countries (CET = continued education and training in the substance abuse field). A structured questionnaire was circulated internationally by an expert committee of the Sw...

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...

This article contributes to the literature on drug users, victimization and offending using data on 545 dependent drug users entering treatment in four European countries. Members of the sample were exposed to high levels of criminal victimization. Sub-groups who were particularly vulnerable to crime were women (and especially sex workers), the hom...

Presenting the results of the third big clinical study on heroin assisted treatment in Europe clinical and scientific evidence of this approach is proved. The targeted population of IVDU not reached by the existing substitution can be addressed effectively. Their health status improves often dramatically. But also delinquency is dropping, consumpti...

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