Social Dimensions of Pharmaceutical Substitution Treatment

Opiate substitution treatment in Poland is based on supervised distribution of methadone or high-dosage buprenorphine in state health care programs. Patients have to go on a daily basis to the clinic to get their medicine – which can be a source of social problems and tensions. About 1800 people are treated in this way. Because of various reasons methadone cannot be prescribed. As an alternative to this type of maintenance treatment, physicians can prescribe low dosages of buprenorphine. The speaker runs one of the two out-patients clinics in Krakow which provide this treatment option, with about 40 patients participating in the program. The majority of them have experience with supervised methadone treatment. Although they perceived methadone as an effective substitution medicine, the distribution method was perceived as utmost problematic. The frequent visits to the clinic interrupted their daily life and the humiliating control measures decreased their self-esteem. The compulsory contacts with other drug addicts caused relapse. Since the social costs are too high, they prefer to be treated by less effective medicines (like low doses of buprenorphine). The treatment in our outpatient clinic gives addicts space to lead a normal life. Every two weeks the patients have psychiatrist's consultation and receive the next prescription. In addition they are obliged to take part in psychotherapy. Despite the fact that buprenorphine works only partly as an opiate agonist, it seems that for many addicts the social dimension of treatment is as important as the pharmaceutical effects of the treatment itself.