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S3 Practice Guideline Methamphetamine-Related Disorders

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S3 Practice Guideline Methamphetamine-Related Disorders Drug Commissioner of the German Federal Government German Federal Ministry of Health (BMG) • German Medical Association (BÄK) • German Association for Psychiatry, Psychotherapy and Psycho- somatics (DGPPN) S3 Practice Guideline Methamphetamine-related Disorders 1st Edition, 2016 © Foreword Foreword Why publish an S3 Practice Guideline on "Methamphetamine-related Disorders”? All appearances might indicate that the increased methamphetamine abuse in Germany is regionally contained. Nonetheless, physicians and staff working in hospitals, private medical practices and addiction treatment centers are confronted with an increasing intensity of this problem. Compared to other stimulants, methamphetamine is a substance with characteristic properties relating to its action, symptoms and potential to create dependence. This is aggra- vated by the fact that the motives for its use vary greatly across a diverse range of population groups (see Chapter 1 Epidemiology). The special needs of patients with methamphetamine- related disorders pose challenges to conventional addiction services. The methamphetamine currently manufactured illegally in Germany comes in the form of a potent crystalline drug (street name “crystal meth”) and possesses a high concentration of the active substance. This crystalline form is also subsumed under the general term "meth- amphetamine” used in this practice guideline. Crystalline methamphetamine is most typically taken nasally, i.e. “snorted” into the nasal passage. Similarly common routes of administra- tion are smoking and intravenous injection. These forms are particularly problematic given their potential for fast addiction, excessive substance use patterns and risks for users to con- tract contagious diseases. Frequently, users will additionally take sedative substances, also referred to as functional co-abuse. These particulars already reported overwhelmingly by other countries have also been confirmed for Germany [1]. Unless one is talking about exclusively experimental use, the comprehensively described severe long-term sequelae associated with methamphetamine, even when taken in modera- tion for non-medical purposes by the typical routes of administration, allow no other overrid- ing conclusion from a therapeutic perspective than that its use is harmful and addictive. There have been certain cases where sporadic oral intake alone might not have a major medical impact [2; 3]. In expert talks between the German Federal Drug Commissioner, addiction prevention and drug policymakers, researchers and stakeholders from practice-based treatment facilities, it became clear that sophisticated evidence-based therapeutic options are needed. This need led the German Federal Ministry of Health (BMG) to initiate a project on the “Development of practice guidelines for the treatment of methamphetamine-dependent individuals”. The Agency for Quality in Medicine (AQuMed) was commissioned by the German Medical Asso- ciation (BÄK) to collaboratively conduct this project with a panel of experts and support them in terms of expertise and methodology. The panel was led by 21 participating experts who included medical practitioners from multiple inpatient and outpatient specialties, psychother- apists, caregivers and social workers. © 2016 2 Editors Editors The Drug Commissioner of the German Federal Government www.dogenbeauftragte.de Federal Ministry of Health (BMG) www.bmg.bund.de www.baek.de German Medical Association (BÄK) Working Group of the German Medical Associations German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) www.dgppn.de III © 2016 Authors Authors Wolf-Dietrich Braunwarth, Michael Christ, Henrike Dirks, Janina Dyba, Roland Härtel-Petri, Timo Harfst, Heribert Fleischmann, Euphrosyne Gouzoulis-Mayfrank, Willem Hamdorf, Ursula Havemann-Reinecke, Peter Jeschke, Marco R. Kesting, Antje Kettner, Michael Klein, Benjamin Löhner, Winfried Looser, Sascha Milin, Josef Mischo, Bernd Mühlbauer, Stephan Mühlig, Jeanine Paulick, Niklas Rommel, Ingo Schäfer, Norbert Scherbaum, Katharina Schoett, Frank Schulte-Derne, Jan-Peter Siedentopf, Frank Vilsmeier, Norbert Wittmann, Norbert Wodarz, Anne Krampe-Scheidler. Members of the consensus group Participating experts Specialty society or organization represented • Wolf-Dietrich Braunwarth, M.D., Nurem- Not representing any society or organiza- berg Medical Center tion • Roland Härtel-Petri, M.D., Psychothera- Not representing any society or organiza- peutic Practice Bayreuth tion • Heribert Fleischmann, M.D., Wöllershof German Centre for Addiction Issues District Hospital (Deutsche Hauptstelle für Suchtfragen e. V., DHS) • Professor Euphrosyne Gouzoulis- German Association for Psychiatry, Mayfrank, M.D. Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie Rhineland Regional Council, Clinic Co- und Psychotherapie, Psychosomatik logne und Nervenheilkund, DGPPN) (Landschaftsverband Rheinland, LVR) • Willem Hamdorf, M.D., Mecklenburg Professional Association for Addiction Hospital of the General Hospital Group (Fachverband Sucht, FVS) (Allgemeine Hospitalgesellschaft [AHG] Klinik Mecklenburg) • Professor Ursula Havemann-Reinecke German Society for Addiction Research and Treatment University Medical Center Göttingen (Deutsche Gesellschaft für Suchtfor- (Universitätsklinik Göttingen) schung und Suchttherapie e. V., DG Sucht) • Peter Jeschke, Diplomate in Medicine, Not representing any society or organiza- Neurological Group Practice, Halle tion • Josef Mischo, M.D., St. Ingbert District Working Group on Drugs and Addiction of Hospital (Kreiskrankenhaus St. Ingbert) the German Medical Association (Ar- beitsgruppe “Sucht und Drogen” der Bun- desärztekammer, BÄK) © 2016 4 Members of the consensus group Participating experts Specialty society or organization represented • Professor Bernd Mühlbauer, M.D. Institu- Drug Commission of the German Medi- te for Clinical Pharmacology, Klinikum cal Association (Arzneimittelkommission Bremen Mitte; Bremen Hospital Group der deutschen Ärzteschaft, AkdÄ) • Professor Stephan Mühlig, Ph.D. Uni- German Psychotherapists’ Association versity of Technology of Chemnitz (Bundespsychotherapeutenkammer, (Technische Universität Chemnitz) BPtK) • Timo Harfst (deputy) German Psycho- therapists’ Association • Ingo Schäfer, M.D., University Lecturer, Centre of Interdisciplinary Addiction University Medical Center Hamburg- Research (ZIS) of the University of Eppendorf (UKE)/Centre of Interdiscipli- Hamburg (Zentrum für Interdisziplinäre nary Addiction Research (ZIS) of the Suchtforschung der Universität Ham- University of Hamburg burg, ZIS) • Sascha Milin (deputy) Centre of Interdisciplinary Addiction Re- search (ZIS) of the University of Ham- burg • Professor Norbert Scherbaum, M.D., Working Group on Drugs and Addiction of LVR Hospital Essen the German Medical Association (Ar- beitsgruppe “Sucht und Drogen” der Bun- desärztekammer, BÄK) • Katharina Schoett, M.D., Ecumenical German Society for Addiction Medicine Hospital Hainich (Deutsche Gesellschaft für Soziale Arbeit in der Suchthilfe, DG SAS) • Frank Schulte-Derne Regional Council German Society for Social Work in Addic- Westfalen-Lippe (LWL) tion Care (Deutsche Gesellschaft für So- ziale Arbeit in der Suchthilfe, DG SAS) • Frank Vilsmeier German Nursing Council Rickling Psychiatric Hospital (Deutscher Pflegerat) • Winfried Looser (deputy) LVR-Clinic Dü- ren • Norbert Wittmann, Mudra Drug Counsel- Mudra – Alternative Youth and Drug Aid ing Center (Mudra – Alternative Jugend- und Dro- genhilfe e. V.) • Benjamin Löhner (deputy) Mudra Drug Counseling Center • Professor Norbert Wodarz, M.D. De- Bavarian Academy for Questions of Ad- partment of Psychiatry and Psychother- diction and Health (Bayerische Akademie apy, University Hospital of Regensburg für Sucht- und Gesundheitsfragen, BAS) V © 2016 Contributions by external experts to specific chapters of this practice guideline Contributions by external experts to specific chapters of this prac- tice guideline Moreover, other experts contributed their professional support to the practice guideline group in drawing up certain chapters without being members of the consensus group itself: Experts Chapter • Professor Michael Christ, M.D. Acute therapy: Emergency setting Department of Emergency Medicine and Internal Intensive Care Medicine, Nu- remberg Medical Center • Niklas Rommel, M.D., D.D.S. Co-occurring disorders: Oral hygiene and dental problems • Professor Marco R. Kesting, M.D., D.D.S. Clinic and Polyclinic for Oral-Maxillofacial and Plastic Surgery, Medical Center “Rechts der Isar”, Technical University of Munich • Jeanine Paulick Pregnant women, young mothers and prenatal harm Department of Psychology, Chemnitz University of Technology Psychotherapeutic interventions • Jan-Peter Siedentopf, M.D., Outpatient Pregnant women, young mothers Clinic for Addiction and Infections in and prenatal harm Pregnancy, Department of Perinatal Med- icine - Campus Virchow-Medical Center, University Hospital Charité – Universi- tätsmedizin Berlin • Jürgen Dinger, M.D., University Lecturer, Pregnant women, young mothers Neonatology and Pediatric Intensive Care and prenatal harm Medicine, Clinic and Polyclinic for Pediat- rics and Adolescent Medicine, University Hospital Dresden • Professor Michael Klein, D.Sc. Methamphetamine abuse in the family context • Janina Dyba, Psychologist, German Insti- tute on Addiction and Prevention Re- search, Catholic University of Applied Sciences, Cologne • Henrike Dirks, D.H.Sc. Methamphetamine abuse
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