{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T09:46:00Z","timestamp":1768988760038,"version":"3.49.0"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"08\/09","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gesundheitswesen"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\nZiel der Studie Die weltweit effektivste Behandlungsform der Opioidabh\u00e4ngigkeit ist die Substitutionsbehandlung mit Opioiden (Opioidsubstitutionstherapie \u2013 OST). Diese Therapieform ist auch in Deutschland etabliert. Jedoch bestehen Versorgungsl\u00fccken, v.\u2009a. in l\u00e4ndlichen Gebieten und einzelnen Bundesl\u00e4ndern, was auf eine abnehmende Anzahl substituierender \u00c4rztInnen zur\u00fcckzuf\u00fchren ist. Mit der 3. Verordnung zur \u00c4nderung der Bet\u00e4ubungsmittel-Verschreibungsverordnung (3. BtMVV\u00c4ndV) in 2017 wurden \u00e4rztlich-therapeutische Aufgaben der OST in die Richtlinienkompetenz der Bundes\u00e4rztekammer \u00fcberf\u00fchrt. Die umfassende Reform der Rahmenbedingungen der OST f\u00fchrt zu einer st\u00e4rkeren Rechtssicherheit dieser Behandlungsform. Die vorliegende Studie zielt darauf ab, die Auswirkungen der 3. BtMVV\u00c4ndV aus der Behandelndenperspektive zu analysieren.<\/jats:p><jats:p>\nMethode Ein Fragebogen zu individuellen Erfahrungen mit den Ver\u00e4nderungen durch die 3. BtMVV\u00c4ndV wurde zwischen August und Dezember 2019 an 2503 substituierende \u00c4rztInnen in Deutschland sowie an 563 nicht oder l\u00e4nger nicht mehr substituierende \u00c4rztInnen in Hamburg, Bayern, Nordrhein-Westfalen sowie Sachsen verschickt. Die Versendung erfolgte \u00fcber die Bundesopiumstelle sowie die Kassen\u00e4rztlichen Vereinigungen der ausgew\u00e4hlten Bundesl\u00e4nder. Die Auswertung differenziert zwischen substituierenden \u00c4rztInnen mit und ohne suchtmedizinische Weiterbildung sowie zwischen st\u00e4dtischen und l\u00e4ndlichen Kreisen.<\/jats:p><jats:p>\nErgebnisse Die R\u00fccklaufquote substituierender \u00c4rztInnen lag bei 34,1%. Das Durchschnittsalter betrug 57,9 (\u00b1\u20098,7) Jahre und 64,5% waren m\u00e4nnlich. Aus substitutions\u00e4rztlicher Sicht waren die relevantesten \u00c4nderungen der 3. BtMVV\u00c4ndV keine zeitliche Vorgabe f\u00fcr das Erreichen einer Opioidabstinenz (85,3%), die neue Bewertung und Behandlung des Konsums weiterer psychotroper Substanzen (71,0%), die M\u00f6glichkeit, die Take-Home-Verordnung auf 30 Tage auszudehnen (70,0%) sowie die gr\u00f6\u00dfere Rechtssicherheit (66,2%). Die Ausweitung der Konsiliarbehandlung auf 10 PatientInnen erfuhr mit 14,8% wenig Zustimmung. 36,7% sah die Versorgung substituierter PatientInnen weder aktuell noch zuk\u00fcnftig gesichert.<\/jats:p><jats:p>\nSchlussfolgerung Die Neuerungen durch die 3. BtMVV\u00c4ndV wurden positiv aufgenommen und hinsichtlich der erh\u00f6hten Rechtssicherheit und therapeutischen Freiheiten als relevant eingestuft. Informationsbedarf besteht in l\u00e4ndlichen Gebieten, bei substituierenden \u00c4rztInnen ohne suchtmedizinische Weiterbildung sowie bei \u00c4rztInnen, die in der Vergangenheit substituierten, es aktuell jedoch nicht mehr tun.<\/jats:p>","DOI":"10.1055\/a-1378-9249","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T23:46:45Z","timestamp":1614642405000},"page":"651-661","source":"Crossref","is-referenced-by-count":4,"title":["Die Substitutionstherapie Opioidabh\u00e4ngiger in Deutschland: Auswirkungen der 3. BtMVV\u00c4ndV aus der Sicht substituierender \u00c4rztinnen und \u00c4rzte"],"prefix":"10.1055","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5326-5673","authenticated-orcid":false,"given":"Kirsten","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf, Zentrum f\u00fcr Interdisziplin\u00e4re Suchtforschung der Universit\u00e4t Hamburg (ZIS), Hamburg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silke","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf, Zentrum f\u00fcr Interdisziplin\u00e4re Suchtforschung der Universit\u00e4t Hamburg (ZIS), Hamburg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd","family":"Schulte","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf, Zentrum f\u00fcr Interdisziplin\u00e4re Suchtforschung der Universit\u00e4t Hamburg (ZIS), Hamburg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-G\u00fcnter","family":"Meyer-Thompson","sequence":"additional","affiliation":[{"name":"Substitutionsambulanz Altona, Asklepios Klinik Nord \u2013 Ochsenzoll, Klinik f\u00fcr Abh\u00e4ngigkeitserkrankungen, Hamburg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Verthein","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf, Zentrum f\u00fcr Interdisziplin\u00e4re Suchtforschung der Universit\u00e4t Hamburg (ZIS), Hamburg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,3,1]]},"reference":[{"key":"ref2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/j.1360-0443.2010.03140.x","article-title":"Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies","volume":"106","author":"L Degenhardt","year":"2010","journal-title":"Addiction"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002209.pub2","article-title":"Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence","volume":"3","author":"R Mattick","year":"2009","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"ref4","volume-title":"Langzeitsubstitutionsbehandlung Opioidabh\u00e4ngiger","author":"M Busch","year":"2007","edition":"(DIMDI) DIfMDuI"},{"key":"ref5","first-page":"247","article-title":"Mortalit\u00e4t in der langfristigen Substitution: H\u00e4ufigkeiten, Ursachen und Pr\u00e4diktoren","volume":"13","author":"M Soyka","year":"2011","journal-title":"Suchtmedizin in Forschung und Praxis"},{"key":"ref6","first-page":"232","article-title":"Der Verlauf und Ausgang von Substitutionspatienten unter den aktuellen Bedingungen der deutschen Substitutionsversorgung nach 6 Jahren","volume":"13","author":"H Wittchen","year":"2011","journal-title":"Suchtmedizin in Forschung und Praxis"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004147.pub4","article-title":"Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence Cochrane Database of Systematic Reviews","volume":"10","author":"L Amato","year":"2011"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s11326-006-0022-1","article-title":"Substanzabh\u00e4ngigkeit vom Morphintyp \u2013 State-of-the-Art der Erhaltungstherapie mit synthetischen Opioiden","volume":"2","author":"G Fischer","year":"2006","journal-title":"Psychiatrie & Psychotherapie"},{"key":"ref10","first-page":"A","article-title":"Substitutions-Richtlinie der Bundes\u00e4rztekammer: Basis f\u00fcr eine bessere Versorgung","volume":"116","author":"W Kunstmann","year":"2019","journal-title":"Deutsches \u00c4rzteblatt"},{"key":"ref11","author":"Bundes\u00e4rztekammer","year":"2017"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"137","DOI":"10.3238\/arztebl.2019.0137","article-title":"Sch\u00e4tzung der Anzahl von Personen mit einer Opioidabh\u00e4ngigkeit","volume":"116","author":"L Kraus","year":"2019","journal-title":"Deusches \u00c4rzteblatt Int"},{"key":"ref14","volume-title":"Gesundheitsberichterstattung des Bundes gemeinsam getragen von RKI und Destatis. 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