Relevance and Effects of the 3rd Revision of the Narcotic Drugs Prescription Ordinance on routine OST care Results of a Qualitative Survey of Substituting Physicians

Background Opioid substitution treatment (OST) is the most important treatment option for opioid dependence in Germany. Despite its effectiveness, structural framework conditions, as well as the reluctance of in particular younger physicians to offer or continue opioid substitution treatment, limits the expansion of this treatment. In 2017, comprehensive reforms for opioid substitution treatment were adopted with the 3 rd revision of the Narcotic Drugs Prescription Ordinance coming into force. As part of an evaluation study of these changes, this article presents the results of guideline-based interviews with substituting physicians. Methods Between December 2019 and April 2020, a total of 31 qualitative interviews with substituting physicians were conducted in German states of Hamburg, North Rhine-West-phalia, Saxony and Bavaria. The interview guidelines contained questions on the innovations adopted in the 3rd revision of the Narcotic Drugs Prescription Ordinance, on structural preconditions as well as ideas for the future organization of opioid substitution treatment. Results The average age of the interviewed physicians was 58.5 years, 77.4% were male and 54.8% worked as liaison and consultant. The changes due to the new substitution guideline are assessed positively. However, there are differences between the federal states in terms of practical relevance. The regulation that extends take-home opioid substitution medication to a maximum of 30 days, the exception from the direct consumption of opioid substitution through visual supervision up to 5 days and reassessing the handling of co-occurring substance use are seen as innovations with practical relevance. A minor benefit is the possibility to treat 10 instead of 3 patients under consultative care. Conclusions The changed regulations are unlikely to be sufficient in attracting new physicians to offer opioid substitution treatment. Cooperations with pharmacies, care facilities and governmental institutions will become increasingly important. Support for independent physicians through substitution outpatient clinics and psychiatric outpatient clinics is necessary. The treatment of addiction should be given greater priority in medical education.