The Sune-Egge is a hospital with a difference: socially disadvantaged people with combined physical and psychiatric conditions receive outpatient and intramural treatment here. The Sune-Egge, which belongs to the Pfarrer Sieber Social Welfare Foundation, is an important point of contact for people from the addiction and homeless environment. Here they are understood and helped.
Monday morning is a busy day: the postman delivers the first parcels and is greeted warmly at the door by a patient who also happens to be at the reception. “Shall I help you with the packages?” he asks the postman. This one has already fully placed its load and therefore refuses with thanks. This atmosphere is characteristic of the entire hospital, although it is hectic, people treat each other with respect and decency.
However, Watson is not on site to analyze the mood. Much more interesting is how the specialists estimate the consequences of a possible methadone deficiency. And how this oft-mentioned and little-explained methadone therapy actually works.
Since December 8, 2022, the company Amino AG is no longer allowed to produce and sell medicines. Reason: The Swiss Agency for Therapeutic Products, Swissmedic, has suspended the operating license and all drug approvals for Amino AG for safety reasons. Problem: Amino AG is the largest manufacturer of methadone tablets in Switzerland.
The suspension of approval for Amino AG applies until the company’s internal shortcomings are remedied, Swissmedic writes in a press release. According to experts, the suspension could lead to a bottleneck.
There are several reasons for revoking the permit. It all started in 2017 when young people broke into two Amino AG properties. After that, more and more shortcomings came to light, which eventually led to the suspension of the license in December.
Sune-Egge, which is on the list of cantonal hospitals and has an official supply mandate, could be affected by the suspension.
Judith Holderer, pharmacy assistant, is currently positive and explains that there will be no bottlenecks at Sune-Egge in the coming weeks. She also hopes that the Amino company will find a solution so that this important drug can be produced and sold again. There are also alternatives, such as liquid methadone or delayed-release morphine. The pharmacist’s assistant explains that these are not manufactured by Amino AG.
The lead physician, Mohannad Abou Shoak, argues that the alternatives to methadone have a different effect from that of methadone. For example, some are non-narcotic. That’s why he thinks some patients reject these alternatives.
But there are also other problems: Backward morphine preparations, for example, cannot be administered to people with kidney problems, because in some cases methadone is the only effective drug, says Abou Shoak.
Holderer is also critical of the switch: “It brings a lot of uncertainty for patients. Many of them have been taking it for years. The drug is very important to her. I can only speak for our house: we currently have enough. I don’t think anyone has to do without it.”
Another problem may be the large additional costs associated with importing methadone from abroad. The pharmacist’s assistant states that the Sune-Egge has not yet processed the order from abroad intensively. “There is a lot of speculation right now. But we trust in the covenant. He and Swissmedic will certainly respond. Any other option would be fatal,” says Holderer.
Mohannad Abou Shoak and his colleague Leela Ritter, practice assistant, who are both on the front lines, emphasize that the current situation is not without problems.
Ritter knows the concerns of the patients, who are often very fixated on the methadone and not open to change: “The potential change scares the patients.”
Abou Shoak is also of the same opinion: “Some patients have been living on the streets for years and have reached their absolute lows due to excessive heroin use. Stabilization with methadone has been a difficult and lengthy process for many. For her, methadone is a sure anchor that got her off the streets. If this suddenly disappears, it can lead to a huge deterioration in their mental state. Some might even take to the streets again to use heroin.”
The three agree: Patients are very uncertain at the moment. After all, it’s all over the media, Judith Holderer interrupts. Abou Shoak confirms his colleague’s statements: “People ask us if they still get their methadone. You’re afraid. A patient told me this morning that it would be catastrophic for her if she stopped taking methadone.”
The Sune-Egge is a specialist hospital with 30 beds and an outpatient clinic at the same time. A large team works together here: doctors, nurses, practice nurses, pharmacist’s assistants, social workers, pastors and wound experts.
The addicted patients receive their opioid agonist therapy on an outpatient basis and are cared for by their primary care physician.
During this therapy, people who are addicted to heroin, for example, are given other opioids. One of the commonly used opioids is methadone.
This form of therapy is officially recognized by the WHO. Because opioid agonist therapy with methadone and other substitutes was one of the most important of several political measures to solve the drug problem in the 1980s and 1990s.
In the Sune-Egge, there are 40 patients on this opioid agonist therapy. But before methadone therapy can begin at all, it must be clear whether the person is actually addicted to opioids: “This way we can rule out abuse and make sure that the person is not trading the methadone for cocaine or anything like that,” Abou explains. Shake.
If you are sure that the person actually suffers from an opioid addiction, you can start therapy relatively quickly, says Abou Shoak. “You start with a low dose. This way you prevent a stupor, an overdose. The dose is increased until the patient no longer has withdrawal symptoms. The aim is to reduce ‘dirty consumption’ on the street,” he explains.
When asked whether the idea is to get people off heroin completely, Abou Shoak replies that the primary goal of methadone therapy is not to get people off heroin completely. But with the help of therapy, damage can be reduced. “The patients develop a tolerance and are protected against overdoses,” says Abou Shoak.
He explains why tolerance is important: “If an addict goes without heroin for a week and then injects themselves with the usual load, it can lead to an overdose because they no longer have tolerance for it. However, if someone is on methadone therapy, this is not the case because the methadone makes them tolerant. So it’s not primarily about getting people off drugs. The ultimate goal is that no more people die on the street from an overdose.”
Of course it’s nice to see more success: “Thanks to methadone, many people find their way back to everyday social life. They can go back to work and meet their friends and family. Without being driven by the addictive pressure of heroin. “
Today, largely thanks to opioid agonist therapy, the heroin problem has lost some of its social urgency compared to the 1980s and 1990s, says Abou Shoak. The doctor summarizes: “Opioid agonist therapy is a very successful form of therapy. That’s why it’s important to find a solution to a possible methadone deficiency.”
