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Opioid replacement therapy
Opioid replacement therapy (ORT) or opioid substitution therapy (OST) is a medical treatment that involves replacing an illegal opioid, such as heroin, with a longer acting but less euphoric opioid; methadone or buprenorphine are typically used and the drug is taken under medical supervision.〔Richard P. Mattick et al.: (National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD): Report of Results and Recommendation )〕 Some formulations of buprenorphine incorporate the opiate antagonist naloxone during the production of the pill form to prevent people from crushing the tablets and injecting them, instead of using the sublingual (under the tongue) route of administration.〔
In some countries, such as Switzerland, Austria, and Slovenia, patients may be treated with slow-release morphine when methadone is deemed inappropriate due to the individual's circumstances. In Germany, dihydrocodeine has been used off-label in ORT for many years, however it is no longer frequently prescribed for this purpose. Extended-release dihydrocodeine is again in current use in Austria for this reason. Research into the usefulness of piritramide, extended-release hydromorphone (including polymer implants lasting up to 90 days), dihydroetorphine and other drugs for ORT is at various stages in a number of countries. The prescription of medicinal heroin or morphine for people with long-term addictions, particularly those who have difficulty with methadone programs, is also legal in some countries.〔
==Rationale==
The driving principle behind ORT is the program's capacity to facilitate a resumption of stability in the user's life, while the patient experiences reduced symptoms of drug withdrawal and less intense drug cravings; however, a strong euphoric effect is not experienced as a result of the treatment drug.〔 In some countries (not the USA, UK, Canada, or Australia),〔 regulations enforce a limited time period for people on ORT programs that conclude when a stable economic and psychosocial situation is achieved. (Patients suffering from HIV/AIDS or Hepatitis C are usually excluded from this requirement.) In practice, 40-65% of patients maintain complete abstinence from opioids while receiving opioid replacement therapy, and 70-95% are able to reduce their use significantly, while experiencing a concurrent elimination or reduction in medical (improper diluents, non-sterile injecting equipment), psychosocial (mental health, relationships), and legal (arrest and imprisonment) issues that can arise from the use of illicit opioids.〔
抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』
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