Opioid Replacement Therapy (ORT) is the medical procedure of replacing an illegal opioid drug such as heroin with a longer acting but less euphoric opioid, usually methadone or buprenorphine, that is taken under medical supervision. In some countries (e.g. Switzerland, Austria) patients may be treated with slow-release morphine where methadone is deemed inappropriate in the circumstances. In Germany, Dihydrocodeine has been used off-label in ORT for many years, however it is no longer frequently prescribed for this purpose. Extended-release dihydrocodeine is again in current use in Austria for this reason. Research into the usefulness of piritramide, extended-release hydromorphone including polymer implants lasting up to 90 days, dihydroetorphine and some other drugs for this purpose is in various stages in a number of countries at present. The prescription of medicinal heroin or morphine for long-term addicts, particularly those having difficulty with methadone programmes, is also done in some countries.
Some formulations of buprenorphine are manufactured in pill form with the opiate antagonist Naloxone to prevent addicts from crushing the tablets and injecting them instead of taking them sublingually (under the tongue).
The driving principle behind ORT is that an opiate addict will be able to regain a normal life and schedule while being treated with a substance that stops him from experiencing withdrawal symptoms and cravings, but doesn't provide strong euphoria. In many countries regulations require that ORT should be applied for a limited time only, as long as needed for the patient to consolidate his economic and psychosocial situation. (Patients suffering from HIV/AIDS or Hepatitis C are usually excluded from this demand.) In practice however only a small fraction of patients manage to attain abstinence.
ORT has been shown to be the most effective treatment for improving the health and living condition of patients. It is also the most effective in reducing mortality as well as overall costs for society. (e.g. those caused by drug-related crime, the prosecution thereof, the spreading of diseases, etc.)
- Heroin assisted treatment
- Michel et al.: Substitution treatment for opioid addicts in Germany, Harm Reduct J. 2007; 4: 5.