{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:45:48Z","timestamp":1774658748855,"version":"3.50.1"},"reference-count":74,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T00:00:00Z","timestamp":1652054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>In 2021, the manufacturer of diamorphine reported a possible impending shortage for Switzerland and Germany. This led us to investigate this controlled medicine\u2019s manufacture, market, and regulatory constraints. Based on our analysis of legal texts and gray literature in the form of reports and documents, we propose recommendations to prevent and address diamorphine shortages in Switzerland. Diamorphine, also known as pharmaceutical \u201cheroin,\u201d is used medically to treat persons with severe opioid use disorder in a handful of countries. The controlled medicine is manufactured from morphine, which, in turn, is extracted from opium poppies. Studying data from the International Narcotics Control Board for 2019, we find that Switzerland accounts for almost half of the worldwide medical consumption of diamorphine. It manufactures more than half of the worldwide total and keeps the largest stocks. Moreover, Switzerland is dependent on a sole supplier of diamorphine (monopoly). As a niche product, diamorphine has an increased risk of shortage. Such a shortage would immediately threaten a valuable public health program for around 1,660 Swiss patients. We believe it is urgent to curtail the monopoly and ensure a stable supply for the future.<\/jats:p>","DOI":"10.3389\/fpsyt.2022.882299","type":"journal-article","created":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T08:49:16Z","timestamp":1652086156000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Switzerland\u2019s Dependence on a Diamorphine Monopoly"],"prefix":"10.3389","volume":"13","author":[{"given":"Caroline","family":"Schmitt-Koopmann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carole-Anne","family":"Baud","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Val\u00e9rie","family":"Junod","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Simon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,9]]},"reference":[{"key":"B1","year":"1961","journal-title":"SR 0.812.121.0 - Einheits-\u00dcbereinkommen von 1961 \u00fcber die Bet\u00e4ubungsmittel, abgeschlossen am 30."},{"key":"B2","year":"2020","journal-title":"Mai 2011 \u00fcber die Verzeichnisse der Bet\u00e4ubungsmittel, psychotropen Stoffe, Vorl\u00e4uferstoffe und Hilfschemikalien (Bet\u00e4ubungsmittelverzeichnisverordnung, BetmVV-EDI)."},{"key":"B3","year":"2021","journal-title":"Lists and directories; 1.1 Authorised Human Medicinal Products."},{"key":"B4","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1192\/bjp.bp.114.149195","article-title":"Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction\u2020.","volume":"207","author":"Strang","year":"2015","journal-title":"Br J Psychiatry."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1136\/bmj.330.7503.1297","article-title":"Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials.","volume":"330","author":"Dijkgraaf","year":"2005","journal-title":"BMJ."},{"key":"B6","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1111\/j.1360-0443.2009.02741.x","article-title":"Heroin-assisted treatment in Switzerland: a case study in policy change.","volume":"105","author":"Uchtenhagen","year":"2010","journal-title":"Addiction."},{"key":"B7","author":"Schaub","year":"2013","journal-title":"Heroingest\u00fctzte Behandlung - Ver\u00e4nderung der Klientel in der Schweiz und Review der Kostenanalysen."},{"key":"B8","doi-asserted-by":"publisher","first-page":"E317","DOI":"10.1503\/cmaj.110669","article-title":"Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment.","volume":"184","author":"Nosyk","year":"2012","journal-title":"CMAJ."},{"key":"B9","author":"Gmel","year":"2020","journal-title":"Heroingest\u00fctzte\/diacetylmorphingest\u00fctzte Behandlung in der Schweiz - Resultate der Erhebung 2019 (Forschungsbericht Nr. 118)."},{"key":"B10","author":"Frey","year":"2021","journal-title":"Situationsanalyse der heroingest\u00fctzten Behandlung (HeGeBe). 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