Artificial heroin at the expense of health insurance

Hamburg: Heroin at the expense of health insurance?

In Hamburg, the delivery of artificial heroin (diamorphine) will be paid in future by the statutory health insurance. The associations of the statutory health insurance funds and the Kassenärztliche Vereinigung Hamburg (KVH) have now concluded a corresponding agreement, in Hanover is a comparable application on the way. Thus, the dosage of diamorphine is gradually becoming part of the health system.

Artificial heroin for the severely dependent
With diamorphine as an artificial replacement for heroin are already being treated in Hamburg already about 50 seriously ill drug addicts, explains Günter Ploß of the National Association of Ersatzkassen. Those affected are no longer treatable with conventional methods such as the administration of methadone, so the expert. Ploss assumes that after the inclusion as a standard benefit in the catalog of benefits of the cash registers, in the future, a total of about 70 to 80 drug addicts in the Hanseatic town of diamorphine can be obtained at cash costs. A corresponding procedure in which physicians, cash registers and city agree on a financing model, runs also in Hanover. „An application was submitted to take over retroactively the financing for the first of October ", said the spokeswoman for the state capital Hannover, Konstanze Kalmus.

New approach in drug policy
The current decision is also an expression of a change in drug policy. After the law allowed the treatment of severe addicts with diamorphine in principle, the release of diamorphine was tested in severely controversial pilot projects to severely dependent persons. The success of the therapy could not be dismissed out of hand and yet the continuation of the projects was in the balance for a long time. In the past year, however, the Bundestag had passed a law that allows the funding of the dispensaries by the health insurance companies. An essential aspect, because the comprehensive legal requirements for the establishment of a corresponding delivery point, make their operation extremely costly. Thus, with the expiry of the pilot projects, the future funding of the facility was extremely uncertain. The agreement, which has now been agreed in Hamburg, ensures the continued existence of the project there.

Strict requirements for delivery points
The delivery points are subject to strict conditions with regard to opening hours, security, personnel and authorized participants. "Such a device is not so easy to stomp out of the ground," also knows Ralf Bade from the Association of Ersatzkassen, which is a contract partner of the Hamburg institution. So the treatment rooms should be remote and open at least twelve hours a day, three physicians must be employed full time explicitly for the task and the artificial heroin must be stored in special vaults. In addition, only drug addicts may participate in the program who have been opioid for at least five years, have two unsuccessful therapies, and are at least 23 years old. In the context of legal legitimacy, these rules have been designed even stricter than in the model experiment, as Konstanze Kalmus explains, so that Hanover does not yet meet the new requirements. Although there is a special permit for the continuation of existing projects until 2011, as the projects in Hannover is subsequently continued, it has not yet been finally clarified.

Regulated life for those affected
In Hamburg, the project is located at the Outpatient Clinic of the Asklepios Clinic North, where the patients are treated psychosocially for more than six months in order to bring them back to normal everyday life. The delivery point in Hanover is part of the Hannover Medical School. The projects should enable the severely dependent despite their drug addiction a regular life. Because that in addition to the health consequences biggest problem de heroin dependence, is the procurement crime. This is completely eliminated by the state-regulated levy. In addition, diamorphine is far purer in composition than the illegally available heroin, which significantly improves the life expectancy of the addict. Also, the administration under medical supervision is a clear advantage and the risk of overdose is virtually eliminated. Whether other cities will follow the example of Hamburg is so far not foreseeable but generally possible. (fp, 16.10.2010)

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