eDekontaminace
[ Informace pro pracovníky a klienty programů a kontaktních center ] 

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Aktuálně ke stažení

 

Přehled článků

Smažím perník - (ne)peču na zuby

Růže - Erysipel

Biopsie a cirhóza jater

Višňák - dobrý sluha, ale zlý pán

Cesty buprenorfinu k injekční aplikaci

Zhodnocení mezinárodního projektu IMPACT

Infekční centrum pro drogové závislé při FN Motol

Metodické materiály k testování na infekce

Vliv pervitinu na dutinu ústní

Infekční endokarditida

Těhotenství, děti a drogy

Test znalostí o hepatitidě C

Bolest a co s ní

Léčba závislosti na alkoholu

Delirium tremens

Porod v terénu?

Záchranná služba a uživatelé drog

Klíšťata a jak na ně?

Virus Hepatitidy C

Zdravotní péče pro Slováky

Stručný latinsko-český zdravotnický slovník

Hojivé masti

Mapování a metodika zvládání somatických komplikací injekčních uživatelů drog

Podávání léků v sociální službě: k další diskusi

Detoxikovat se sám nebo s pomocí?

HIV poradenství u vybraných rizikových skupin

Brouci pod kůží a v hlavě

Absces známý neznámý

Paraziti a jejich vnímání

Mýty o první pomoci

Neléčená žloutenka typu C

Omrzliny

Substituční programy v Praze

Doporučení k lékaři

Leták o hepatitidě typu C

Mastičky

Konference Imp.Ac.T.

Zuby a jedy

Srdeční endokarditida podrobně

Plísně & masti

Méně známé kousky - chlamydie a genitální opar

Už máš HIV (testy)?

AIDS - jak to všechno začalo

Třicátník stále ve formě

Poleptání

Epileptické záchvaty

Co víš o žloutence C? (anketa)

Kdo sbírá céčka? A co na obranu před žloutenkami?

Žloutenka C - přehledová tabulka aneb co vás čeká až jí dostanete

Ach jo... (aneb vši, muňky, filcky, vyrážky a mykóza)

Jsem v tom! (?)

Zuby dělaj člověka...

Kterak neotěhotněti

BEWARE - Syfilis is coming!

MUDr. Řehák: Je dobrý to řešit

Hepatitida typu C

Zásady testování

Rady všemi mastmi mazané

Popáleniny

Není to jen o cucání

Subuxone - nová šance?

Chutná to líp

Petrolejové lampy - Syfilis

Miminka s absťákem

Testování hepatitidy typu C v káčku - bakalářská práce

Subutex: lék, nebo fet?

Subáč v žíle

Jít nebo nejít na detox?

Biomaso, čili vřed bércový

Stručná historie substituce

Co na rány, boule a tělní krátery?

Co je to substituce?

Co všechno ještě nevíte o bezpečném sexu a vědět byste měli

Abscesy atd. včetně protiinfekčního dvanáctera

Já rád játra! Ty rád játra?

TBC

Miminka a drogy

Testy na žloutenku

Proč se zuby kazí?

Víš co bereš?

Závislost na jehle

Partneři

Stručná historie substituce

15.12.2010 | Sekce: Zdravotní

Vyšlo v Dekontaminaci - Podzim 2008

 

Článek se zabývá dějinami substituční terapie nejen v České republice, ale i ve Velké Británii i USA. Impulsem pro rozvoj substituční terapie ve světě bylo především zneužívání kokainu vojáky po první světové válce.

Historie substituce sahá do první poloviny 20. století. Po první světové válce začaly některé státy řešit problémy související s drogovou závislostí, hlavně v souvislosti se zneužíváním kokainu vojáky.

 

Zákazy
V letech 1916 bylo ve Velké Británii postaveno mimo zákon držení kokainu a opia (kromě kokainu a derivátů opia předepsaných lékařem). V USA vyšel zákon ustavující kontrolu nad držením a distribucí drog již roku 1914, povoloval použití drog pro lékařské účely, nicméně již roku 1922 Spojené státy rozhodly, že pokud lékař předepíše drogu závislému, dopouští se zločinu.

 

Substituce v USA

Přestože předepisování drog bylo v USA nezákonné, začali počátkem šedesátých let 20. století dva psychiatři, dr. Marie Nyswander a dr. Vincent Dole, předepisovat svým pacientům závislým na opiátech metadon. Rozpracovali systém pravidel „Metadonové udržovací léčby". Nyswander a Dole používali velmi vysoké dávky metadonu (80-150mg) a dodnes je v americké tradici zvykem předepisovat mnohem vyšší dávky metadonu, než v Evropě.

 

Substituce ve Velké Británii

V Británii mohli lékaři v rámci léčby předepisovat návykové látky - předepisovali pacientům, u nichž nebylo možné v současné chvíli dosáhnout abstinence, heroin či morfin. Existovaly drogové kliniky, kde byly pacientům podávány chemicky čisté látky, často intravenózně (na většině klinik byly k dispozici tzv. šlehárny).
V šedesátých letech dvacátého století došlo k obrovskému boomu užívání psychotropních látek. Zasloužilo se o to hnutí hippies, ale i např. válka ve Vietnamu, kde vojáci masivně užívali heroin k utlumení bolesti a válečných traumat. Bylo zjištěno, že většina mladých lidí neužívá opiáty ke snížení bolesti, ale pro vyvolání pocitů euforie. Během sedmdesátých let se britští lékaři začali přiklánět k orálně (formou nápoje) podávané substituční látce (metadonu) a cílem se stala klientova abstinence. Později, když se začalo mezi uživateli drog šířit HIV došlo z preventivních důvodů k rozšíření spektra substitučních programů tak, aby byli dostupné pro co nejvíce uživatelů. Od té doby se programy liší v nárocích na disciplínu i abstinenci.

 

Substituce v ČR

Prvním oficiálním zařízením tohoto typu u nás byl pražský Metadonový program Apolinář, spuštěný v červenci 1997. V současné době je v provozu celkem 11 substitučních center, v nichž se v roce 2007 léčilo 449 pacientů. Další dvě centra jsou ve věznicích - v pražské vazební věznici na Pankráci a v Příbrami. Od roku 2003 je v  České republice k dispozici Subutex®, čímž se výrazně rozšířila dostupnost substituční léčby. Subutex totiž mohou předepisovat všichni lékaři, kteří vedou opiátovou knihu, tzn. že mají k dispozici  recepty s modrým pruhem. Tento recept se vyplňuje trojmo - jednu kopii si nechává pro svoji evidenci lékař, jednu kopii si nechává lékárna, která lék pacientovi vydá a originál zasílá lékárna zdravotní pojišťovně. A v únoru 2008 přišel Suboxone, jako nová šance pro lidi, kteří chtějí skončit s injekčním užíváním opiátů.

 

Aleš Herzog

Terénní programy o.s. SANANIM

 

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