{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T21:25:52Z","timestamp":1788297952081,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,10,15]],"date-time":"2018-10-15T00:00:00Z","timestamp":1539561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Department of Public Health of the canton of Zurich"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and aims<\/jats:title><jats:p>Opioid agonist treatment (OAT) is currently the most effective treatment for people with opioid dependence. In most countries, however, access to the whole range of effective medications is restricted. This study aims to model the distribution of different OAT medications within a naturalistic and relatively unrestricted treatment setting (Zurich, Switzerland) over time, and to identify patient characteristics associated with each medication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used generalized estimating equation analysis with data from the OAT register of Zurich and the Swiss register for heroin\u2010assisted treatment (HAT) to model and forecast the annual proportion of opioids applying exponential distributions until 2018 and patient characteristics between 1992 and 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data from 11\u2009895 patients were included in the analysis. Methadone remains the mainstay of OAT, being prescribed to two\u2010thirds of patients. Following its approval, the proportion of HAT increased rapidly and is now constant at 12.16% [95% confidence interval (CI)\u00a0=\u00a011.15\u201313.17]. The initial increase of proportions of buprenorphine or slow\u2010release oral morphine (SROM) following their approval for OAT was slower. While in 2014 both medications had a proportion of 10.2% and 10.3%, respectively, our model predicts a further increase of SROM to 19.9% in 2018, with a ceiling level of 25.19% (21.40\u201328.98%) thereafter. SROM patients display characteristics similar to those treated with methadone; buprenorphine patients show the highest social integration; and HAT patients are the most homogeneous group, with highest mean age, most widespread injecting experience and lowest social integration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Based on data from Zurich, Switzerland from 1992 to 2015, there is no evidence for an excessive demand for a single medication in a naturalistic and liberal opioid agonist treatment setting. Rather, the specific patient characteristics associated with each medication underline the need for diversified treatment options for opioid dependence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14442","type":"journal-article","created":{"date-parts":[[2018,9,13]],"date-time":"2018-09-13T01:26:36Z","timestamp":1536801996000},"page":"103-111","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["One size does not fit all\u2014evolution of opioid agonist treatments in a naturalistic setting over 23 years"],"prefix":"10.1111","volume":"114","author":[{"given":"Carlos","family":"Nordt","sequence":"first","affiliation":[{"name":"Department for Psychiatry, Psychotherapy and Psychosomatics, Centre for Addictive Disorders University Hospital of Psychiatry Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3088-0331","authenticated-orcid":false,"given":"Marc","family":"Vogel","sequence":"additional","affiliation":[{"name":"Division of Addictive Disorders University of Basel Psychiatric Hospital  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Dey","sequence":"additional","affiliation":[{"name":"Swiss Research Institute for Public Health and Addiction University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Moldovanyi","sequence":"additional","affiliation":[{"name":"Polyclinics for Heroin Prescription Lifeline\/Crossline City Medical Services  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilo","family":"Beck","sequence":"additional","affiliation":[{"name":"Arud Centres for Addiction Medicine  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toni","family":"Berthel","sequence":"additional","affiliation":[{"name":"Integrierte Psychiatrie Winterthur Z\u00fcrcher Unterland  Winterthur Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Walter","sequence":"additional","affiliation":[{"name":"Division of Addictive Disorders University of Basel Psychiatric Hospital  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erich","family":"Seifritz","sequence":"additional","affiliation":[{"name":"University Hospital of Psychiatry Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth M.","family":"D\u00fcrsteler","sequence":"additional","affiliation":[{"name":"Department for Psychiatry, Psychotherapy and Psychosomatics, Centre for Addictive Disorders University Hospital of Psychiatry Zurich  Zurich Switzerland"},{"name":"Division of Addictive Disorders University of Basel Psychiatric Hospital  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Herdener","sequence":"additional","affiliation":[{"name":"Department for Psychiatry, Psychotherapy and Psychosomatics, Centre for Addictive Disorders University Hospital of Psychiatry Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,10,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2010.03140.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/HRP.0000000000000052"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.13.1689"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j3881"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6450a3"},{"key":"e_1_2_9_7_1","unstructured":"European Monitoring Centre for Drugs and Drug Addiction. European Drug Report 2017: Trends and Developments. Luxembourg: Publications Office of the European Union; 2017. Available at:http:\/\/www.emcdda.europa.eu\/publications\/edr\/trends\u2010developments\/2017(accessed 7\u00a0June 2017) (Archived at http:\/\/www.webcitation.org\/72q6g5JrW on 1 October 2018)."},{"key":"e_1_2_9_8_1","volume-title":"Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence","author":"World Health Organization","year":"2009"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.2006.163.11.1905"},{"key":"e_1_2_9_10_1","unstructured":"European Monitoring Centre for Drugs and Drug Addiction. Data and statistics: opioid substitution treatment clients by OST medication 2017. 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