Operational and clinical procedures of heroin-assisted treatment in Switzerland: a nation-wide survey study

Background

Heroin-assisted treatment (HAT) was introduced in Switzerland in 1994 and comprises the prescription of diacetylmorphine (DAM, heroin) for patients with severe opioid use disorder. Provision of Swiss HAT is limited to specialised treatment centres, 22 of which operate today. The aim of this study was to assess the characteristics and clinical procedures of these centres.

Methods

A questionnaire was designed and sent out to all operating Swiss HAT centres.

Results

The response rate was 91% and all questionnaires were filled in by the medical heads of the corresponding centres. All centres employed psychiatrists and prescribed psychiatric medication. Additionally, 85% reported to offer in-house psychotherapeutic treatment and 95% reported to employ social workers. Few treatment barriers to HAT were found, with the mean time from referral to treatment initiation being 10 days. Only one centre reported to employ a waiting list. Off-label prescriptions, including intramuscular and intranasal administrations, were common. All centres offered the concurrent prescription of methadone and slow-release oral morphine. Furthermore, all centres prescribed take-home DAM. However, vast differences among centres regarding DAM dosing and titration were found. No uniformly employed factors for converting DAM to other opioids exist across centres. Overdoses and seizures were reported to be very rare.

Conclusions

Swiss HAT is overall easily accessible, patient-centred and safe for patients and staff. Some procedures are based on local tradition rather than on scientific evidence. Evidence-based treatment recommendations are needed to further improve quality of care.