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Patients’ Perceptions of Opioid Replacement Therapy: a Comparison of Diamorphine and Methadone/Levomethadone

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Abstract

Diamorphine was first legalized as a novel treatment option for heroin dependence in Germany in 2009. Today, specialized clinics in ten German cities provide diamorphine to heavily addicted patients. As the medical and societal context of diamorphine-assisted therapy is evolving, continued research into patients’ perceptions of opioid replacement therapy remains important. From February 2018 to June 2018, we conducted a survey study of outpatients on maintenance treatment with either diamorphine (n = 85) or methadone/levomethadone (n = 126). Patients were asked to complete a self-report questionnaire querying, besides socio-demographic information, the study participant’s satisfaction with the substitute drug, relapse with illicit drugs, patterns of craving, and alcohol consumption. Duration of opioid dependence did not differ significantly between groups. Patients on diamorphine were approximately 3 years younger than patients on methadone/levomethadone. They also had a higher frequency of daily intake of their substitute drug and had had their dosage adjusted more often during the preceding 6 months. Still, diamorphine patients reported greater satisfaction with their substitute drug in tandem with significant reductions in relapse-related behaviors and cravings. While the most common relapse reported by patients on methadone replacement was heroin relapse (68%), most instances of illicit drug use in the diamorphine group involved cocaine (48%). Although self-reported alcohol consumption did not differ significantly between groups, a higher percentage of diamorphine patients than methadone patients endorsed decreased alcohol consumption since entering therapy. Taken together, these findings point to meaningful differences between diamorphine and methadone/levomethadone in opioid replacement therapy.

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Acknowledgments

The authors gratefully acknowledge the patients who participated in this anonymous survey. We would also like to thank clinic staff for their support in recruiting respondents.

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Authors and Affiliations

  1. Faculty of Natural Sciences, Department of Psychology, MSB Medical School Berlin, Berlin, Germany

    Stephanie Paula Elisabeth Guillery, Sören Enge & Hagen Kunte

  2. Charité Center 15 for Neurology, Neurosurgery and Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Stephanie Paula Elisabeth Guillery, Rainer Hellweg & Hagen Kunte

  3. Praxiszentrum Kaiserdamm, Berlin, Germany

    Ulrich Bohr

  4. College of Life Sciences, Leicestershire Partnership National Health Service Trust, University of Leicester, Leicester, UK

    Golo Kronenberg

Authors
  1. Stephanie Paula Elisabeth Guillery
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  2. Rainer Hellweg
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  3. Sören Enge
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  4. Ulrich Bohr
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  5. Hagen Kunte
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  6. Golo Kronenberg
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Corresponding authors

Correspondence to Stephanie Paula Elisabeth Guillery or Golo Kronenberg.

Ethics declarations

The project had been pre-approved by the institutional review board of the MSH Medical School Hamburg.

Ethical Standards

The authors assert that all the procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, revised in 2008.

Conflict of Interest

Stephanie P. E. Guillery, Sören Enge, and Golo Kronenberg report no conflict of interest. Rainer Hellweg has received honoraria from AstraZeneka, Janssen-Cilag, Lundbeck, Merz, Novartis, Otsuka, Pfizer, and Servier. Ulrich Bohr has received honoraria from AbbVie Deutschland GmbH & Co. KG, Bristol-Myers Squibb GmbH & Co KGaA, GILEAD Sciences GmbH, Janssen-Cilag GmbH, MSD Sharp & Dohme GmbH, Sanofi-Aventis Deutschland GmbH, and ViiV Healthcare GmbH. Hagen Kunte has received honoraria from Bayer, Biogen, Genzyme, Merck, Novartis, Roche, and Teva.

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Guillery, S.P.E., Hellweg, R., Enge, S. et al. Patients’ Perceptions of Opioid Replacement Therapy: a Comparison of Diamorphine and Methadone/Levomethadone. Int J Ment Health Addiction 19, 2194–2203 (2021). https://doi.org/10.1007/s11469-020-00313-0

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  • DOI: https://doi.org/10.1007/s11469-020-00313-0

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