Substitution-assisted treatments in case of opioid dependence

Substitution treatment is aimed at opioid-dependent people. A substitute substance is prescribed as part of a therapy that also comprises psychosocial support.

Basic principles

Substitution treatment is aimed at opioid-dependent people. A substitute substance is prescribed as part of a therapy that also comprises psychosocial support.

In Switzerland, there has been a legal basis for the use of methadone as a substitute substance to treat people dependent on opioids since 1975. Substitution therapy has proven effective in many scientific studies and is now one of the standard approaches for addressing opioid dependence. In Switzerland, there are around 18,000 people in substitution therapy with methadone or buprenorphine, and around 1,700 people in treatment using diacetylmorphine (pharmaceutical heroin).

Goals of substitution therapy

The goals of substitution therapy are:

  • to build a long-term therapeutic alliance
  • to improve the physical and mental health of those affected and to promote their social integration
  • to facilitate low-risk use and to create the conditions for permanent abstinence
  • to distance those affected from the illegal drug scene and to prevent drug-related crime.

Delivery of treatment

Substitution treatment using opioids such as methadone and buprenorphine, or other long-acting oral opioids, fall under the remit of the cantonal authorities (cantonal medical officer), who has to issue a licence. Treatment is mainly administered by general practitioners (approx. 60%), but also by hospitals, psychiatric services and specialised institutions. The task of dispensing substitute substances may be delegated to pharmacies.

With regards to diacetylmorphine-assisted treatment, it is subject to certain special provisions, for which the Federal Office of Public Health (FOPH) is directly responsible. It is administered in specialised institutions (see the relevant section).  

Medical recommendations

The Swiss Society of Addiction Medicine issues medical recommendations on substitution treatment, which are regularly updated.

General practitioners can find the necessary information on clinical treatment of dependent persons on the website of the Swiss addiction medicine practice (in German, French and Italian only; see link).

What the FOPH does

The Federal Office for Public Health is involved in substitution treatment at several levels:

  • supporting the compilation and publication of recommendations for substitution therapies
  • supporting regional networks of general practitioners
  •  organising regional and national events on the treatment of people with opioid dependence
  • assisting with thematic publications
  • compiling statistics on substitution therapies (see act-info)

For measures within the competence of the FOPH relating to diacetylmorphine-assisted treatment, please refer to the relevant section.

Last modification 16.09.2021

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Contact

Federal Office of Public Health FOPH
Prevention Non-communicable diseases Division
Schwarzenburgstrasse 157
3003 Berne
Switzerland
Tel. +41 58 463 20 43
E-mail

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https://www.bag.admin.ch/content/bag/en/home/gesund-leben/sucht-und-gesundheit/suchtberatung-therapie/substitutionsgestuetzte-behandlung.html