Report on the Drug Situation 2010 - Bundesministerium für ...

Apart from the process of guideline production, which still is in its early stages, also
other actions have been undertaken in Austria to enhance or ensure the quality of
medical treatment. In the specific case of substitution treatment for patients addicted
to opioids, a regulation has existed for many years already, adopted for reasons of
quality assurance and as a response to safety and health policy concerns. The first
ordinance (an internal decree with instructions by the Minister for Health to the health
authorities and public health officers responsible for the supervision of oral opioid
substitution treatment) was issued in 1987. In accordance with the principle of last
resort provided under the then Narcotic Drugs Act, it was not permitted to prescribe
oral substitution medications for the sole reason of severe, treatment-resistant
addiction to opiates: it had to be established in every individual case that any other
form of treatment was extremely unlikely to bring about the desired results. Only after
the adoption in 1998 of the Narcotic Substances Act was substitution treatment
explicitly recognised by law as one of several possible forms of treatment. In 2007 the
aforementioned ordinance was replaced by a decree which also lays down a binding
framework for attending doctors (GÖG/ÖBIG 2007b as well as Chapters 1.1 and 5.1). A
further decree was issued according to which the delivery of substitution treatment
services requires the attending doctors’ completion of further training in OST
(GÖG/ÖBIG 2006 as well as Chapter 1.1 and 5.1).
In Austria, consensus papers drawn up in cooperation with, and initiated by, experts or
professional associations have frequently been drawn up in order to promote uniform
standards of treatment. These consensus papers are typically based on practical
experience, while scientific evidence tends to be taken into account only indirectly and
not in a systematic way. If scientific publications (e.g. Fischer/Kayer 2006, Busch et al.
2007) or guidelines (e.g., from Germany) are available when consensus papers are
prepared, they will be considered for the paper, however. On the other hand, Austrian
experts in turn have also been asked to contribute to guidelines drawn up in other
countries or by international organisations (see Chapter 7.2). Many experts argue that
it is reasonable to draw on practical experience as an essential source of knowhow for
preparing consensus papers, as years of daily work indeed provide an invaluable basis
of evidence which, in a complex process of careful decision-making, also take into
account the individual situation of addicted patients (ÖGABS 2009). According to these
experts, the drawback of relying on a scientific evidence base is that it primarily
considers the results of clinical trials published in high ranking journals, and the
conditions under which such studies are carried out often differ from actual practice.
Moreover, in this context one has to bear in mind that the results or recommendations
from other countries are influenced by the drug policies and also possible restrictions
in those countries and caution has to be exercised when translating such findings to
other countries. This particularly applies to substitution treatment delivered to people
addicted to opioids, because in Austria a wider range of medications may be
prescribed than in other countries.
Chapter 11 / History, Methods and Implementation of National Treatment Guidelines 101