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Hamburg: heroin at the expense of health insurance?
In Hamburg, the supply of artificial heroin (diamorphine) will in future be paid for by the statutory health insurance companies. The associations of statutory health insurers and the Association of Statutory Health Insurance Physicians Hamburg (KVH) have now concluded a corresponding agreement; a comparable application is on the way in Hanover. The diamorphine levy is gradually becoming part of the healthcare system.
Artificial heroin for the severely addicted
About 50 seriously ill drug addicts are currently being treated with diamorphine as an artificial substitute for heroin in Hamburg, explains Günter Ploß from the State Association of Replacement Funds. Those affected can no longer be treated with conventional methods such as the administration of methadone, according to the expert. Ploß assumes that, after being included as a standard service in the health insurance catalog, around 70 to 80 drug users in the Hanseatic city can receive diamorphine at health insurance costs. A corresponding procedure in which doctors, health insurers and the city agree on a financing model is also running in Hanover. "An application was submitted to take over the funding retroactively on October 1," said the spokeswoman for the state capital of Hanover, Konstanze Kalmus.
New approach to drug policy
The current decision is also an expression of a change in drug policy. After the law allowed the treatment of severely dependent persons with diamorphine in principle, the delivery of diamorphine to severely dependent persons was tested in seven highly controversial pilot projects. The success of the therapy could not be dismissed out of hand, but the continuation of the projects was long on the brink. Last year, however, the Bundestag passed a law that allows health insurance providers to fund the delivery points. An important aspect, because the extensive legal requirements to set up a corresponding delivery point make their operation extremely costly. With the end of the pilot projects, the future financing of the facility was extremely uncertain. The agreement now agreed in Hamburg ensures the continued existence of the project there.
Strict requirements for delivery points
The delivery points are subject to strict requirements with regard to opening times, security, staff and approved participants. "Such a facility is not so easy to stamp out of the ground," says Ralf Bade from the Association of Substitute Health Insurance Funds, who is the contractual partner of the Hamburg facility. For example, the treatment rooms should be isolated and open at least twelve hours a day, three full-time doctors must be explicitly employed for the task, and the artificial heroin must be stored in special vaults. In addition, only drug addicts who have been opiate dependent for at least five years, have had two unsuccessful therapies and are at least 23 years old may participate in the program. Within the framework of legal legitimacy, these rules have been set up even more strictly than in the model test, 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, it is not yet clear how the project will be continued in Hanover afterwards.
Regulated life for those affected
In Hamburg, the project is located at the ambulance of the Asklepios Klinik Nord, where those affected are given psychosocial care for more than six months in order to transfer them back to normal everyday life. The delivery point in Hanover is part of the Hannover Medical School. The projects are intended to enable the severely dependent to have a regular life despite their drug addiction. After all, besides the health consequences of heroin addiction, the biggest problem is procurement crime. This is completely eliminated by the state-regulated levy. In addition, diamorphine is far purer in its composition than the illegally available heroin, which significantly improves the life expectancy of addicts. Administration under medical supervision is also a clear advantage and the risk of overdoses is virtually eliminated. It is generally not yet possible to predict whether other cities will follow the example of Hamburg. (fp, 16.10.2010)
Heroin delivery is covered by health insurance companies