Substitution judgment to take-home regulation

substitution: Doctors are not to blame for take-home damage to their patients.

01/29/2014

As a matter of principle, physicians are only allowed to bring home methadone, polamidone or another replacement drug in the case of drug substitution therapy in clearly defined exceptional cases. The doctor must justify his decision in such cases sufficient. For him, the question of whether the take home regulation supports the treatment progress of the patient in question is of central importance. This is the case, for example, if it positively influences the reception or retention of a job. According to the specifications of the German Medical Association, this is only permissible if the course of treatment has stabilized in every respect. In addition, the patient receives an always consistent dose of his replacement drug.

Only preparations containing levomethadone, methadone, buprenorphine or a medicinal product authorized for substitution may be prescribed as substitute. In justified exceptional cases, codeine or dihydrocodeine may also be prescribed. The federal government has the legal requirements of a substitution-based treatment drug addict in the §§ 5 and 5a of the Narcotics Prescription Ordinance (BtMVV) and only those physicians who have undergone specific addiction medicine training may prescribe substitution drugs.

A patient dies „Take-Home“- Procedure, the doctor can not be held criminally responsible, recently ruled the Federal Court (BGH) in Karlsruhe. This was a verdict of the district court Deggendorf against a doctor in Bavaria, confirmed. He had treated drug-dependent substitution patients between 2006 and 2011. As a rule, patients must take the prescribed substitute under supervision in practice in order to prevent abuse. In at least four patients, the doctor but so-called "take home prescriptions" for the replacement drugs methadone or levomethadone.

Patients who are prescribed such a prescription can pick up their replacement drug even in the pharmacy and then take it independently, without medical supervision. In the dispute, the doctor had issued one of his patients five "Take Home Regulations" in a row, without having personal contact with him during this time. The patient later died of an overdose of methadone. The district court Deggendorf accused the doctor now that he accepted it approvingly that the addict and other patients do not take the methadone as intended. In addition, the doctor had not sufficiently controlled the possible "Beikonsum" of other drugs. Thereafter, the medical practitioner was sentenced by the district court for "unauthorized prescription of narcotics" to a fine of 360 daily sentences, which is about a penalty equivalent to one year's income.

In contrast, the district court the doctor from the charge of a negligent homicide free. The patient was "in danger of self-responsibility, aware of the risk of overdose", it says in the judgment. This decision making is certainly a tightrope walk, because it is part of the medical oath to save lives in every way. But one must demand the patient a certain own responsibility, so the judges. After all, the aim of the substitution treatment is to return the patient to the patient „normal“ to enable everyday life. (Fr)

Picture: Sigrid Rossmann