Experience in Work with Centralized Intake Model (Checkpoints) for Methadone Substitution Therapy in Dubrovnik

INTRODUCTIONOne of the major problems in psychiatry is working with severe drug addicts (addiction to opiates - heroin, methadone, etc.). After the Homeland War, addiction in Croatia had taken on alarming proportions. The treatment of addicts is a long-term and very complex process and requires a wide range of biological and psychosocial methods with the support of local communities, but also the entire society so as to make sure that the process is even more successful. One of important factors in the approach to drug users is the need for a better control in treatment. One of important factors in the approach to drug users is the need for a better control in treatment.Since the Second World War in most countries of the world, production, supply and consumption of alcoholic beverages, tobacco, psychoactive drugs and other illicit drugs has steadily increased. Misuse of these funds has become a trans-cultural phenomenon. Extensive work has been carried out all around the world to reduce this problem in all its levels and aspects.1'2In a 5-year follow-up study carried out by Gossop and colleagues reductions in convictions for acquisitive, sale of drugs, and violent crimes were discovered.3Scherbaum and colleagues confirmed that take-home dosages in maintenance treatment are of great therapeutic importance, but they include the risk of the substitute being distributed illegally.4In randomized controlled trials carried out by Sees and colleagues it was noted that methadone maintenance therapy resulted in greater treatment retention (median, 438.5 vs 174.0 days) and lower heroin use rates than did detoxification.5In the study of Connors it was noted that the sample of patients was overall slightly satisfied with methadone maintenance treatment.6Until the development of the Glasgow supervised methadone program (1994.) it was common practice in the United Kingdom for methadone to be supplied to patients to take away for consumption elsewhere. The dispensing of a supply for a whole week or longer was commonplace and a supply for one month was not unusual.7In 1994, when the Glasgow Drug Problem Service was set up, it was decided to actively promote the concept of supervised consumption of methadone in community pharmacies.8During the middle 90-ies in UK was recommended by the British Department of Health's to increase the involvement of community pharmacists in the care of addicted drug users and to expand the range of services they offer to drug users.9In their article Roberts and Hunter outlines the evolution of a community pharmacy-based supervised consumption of methadone program in Grater Glasgow. The formalization of this program in 1994 promoted full patient compliance with the methadone regimen and reduced seepage of the drug to the illicit market.10In Croatia methadone for the treatment of addicts was introduced through the »slightly open door«. The introduction of methadone therapy can be divided into an implementation (1991.-1996.) and consolidation phase (1996.-2001.) In a couple of months the first few hundreds of addicts entered the programme; by the end of 1995, over 1500 had been treated. There were no significant problems in prescribing and dispensing methadone, but it became evident that centralized methadone induction was insufficient and needed to be changed. Finally, in 1996 the Croatian Parliament approved the »National strategy for drug abuse control«, the first document to be issued on the prevention and treatment of addiction, and on limiting the supply of illegal drugs. The crucial innovation was the idea of establishing »Centres for outpatient treatment« in all counties and bigger towns, with the aim of helping to set up specialized units and enhancing the availability of treatment. "After 1996, Centres for Outpatient Treatment were established in all the areas facing drug problems; so far there have been 15 of these. Again, it was not the central administration that decided on this important step, but local communities, who took the initiative and provided the funding. …