Prolonged Dam-Take-Home in Times of COVID-19: Harm Reduction or Increase?

Author: Franciska Brezan Jonas Montagna Luis Falcato Philip Bruggmann

Theme: Clinical Research Year: 2022

Background: The maximum allowed take-home prescription of diacetylmorphine (DAM) for heroin
assisted treatment in Switzerland was extended in the context of the Corona pandemic by the
government from two to six days. Our institution implemented the extended delivery for all patients
assessed as stable by the therapists.
To assess the consequences of prolonged take-home prescription, 134 DAM patients were studied in
a retrospective medical record analysis by comparing the year before with the year after the change
in delivery practice. Potential predictive factors examined were gender, age, use of DAM i.v., and
prescription of stimulants, benzodiazepines, antidepressants, or neuroleptics. As consequences of
extended delivery, the respective number of additional DAM dispensing events, emergency
hospitalizations, antibiotic therapies, and number of jail stays were compared.
Prolonged take-home prescription was not associated with significant changes in DAM dosing (p =
0.418), emergency hospitalizations (p = 0.267), antibiotic therapies (p = 0.202), or jail stays (p =
0.181). The mean number of additional DAM dispensing events increased from 0.33 to 0.98 (p =
0.005) over the years.
In 106 (79.1%) of 134 patients, prolonged take home was maintained throughout the year.
Multiple regression analysis showed that i.v. use of DAM (OR = 2.98 CI-95: 1.23 – 7.23) and
benzodiazepine prescription (OR = 2.74, CI-95: 1.11 – 6.75) were associated with reduction of takehome prescription. Age, gender, dosage of DAM, other prescribed medications had no effects. Mean
number of additional DAM dispensing events was 0.56 in the group with maintained take-home vs.
2.57 in the group with reduced prescription (p = 0.005).
Most patients – especially those without i.v. use or benzodiazepines – used their 6-day supply of oral
DAM without negative effects on therapeutic and somatic stability. Our study does not provide any
evidence against maintaining the extended delivery practice beyond the pandemic.
Disclosure of Interest Statement:
The authors declare no conflict of interest.

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