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Zusammenfassung Einleitung Multimorbidität im Alter ist u. a. ein Grund für intensivierte Pharmakotherapie. Gleichzeitig kann es mit steigender Medikamentenzahl zu einer Zunahme der Multimorbidität kommen, insbesondere wenn Interaktionen zwischen den Wirkstoffen zu unerwünschten Arzneiwirkungen (UAW) führen. Ziel dieser Untersuchung war es, in einer Pilotstudie Patienten zu identifizieren, die einem erhöhten Risiko für UAW unterliegen. Methoden In einer Querschnittserhebung wurden 918 in Heimen lebende psychiatrisch behandelte Alterspatienten untersucht (Altersmittel: 79,3 (±11,6) Jahre; 31,8 % Männer). Es kamen exemplarisch verschiedene Methoden zur Identifikation von möglichen Risikopatienten zur Anwendung: eine die Interaktionen der Gesamtmedikation erfassende „Clinical-Decision-Support-Software“(CDSS)-Onlinedatenbank, mediQ, und eine Negativliste, die pauschal zu vermeidende Präparate indiziert, die PRISCUS-Liste. Ergebnis Es hatten 76,3 % aller Studienpatienten bei Betrachtung der Gesamtmedikation ein klinisch relevantes Interaktionsrisiko (IR), 2,2 % standen unter einem darüber hinausgehenden potenziell starken UAW-Risiko durch Interaktionen. Ungefähr ein Viertel der untersuchten Studienpopulation erhielt potenziell inadäquate Medikamente gemäß PRISCUS. Schlussfolgerung Diese unterschiedlichen Zahlen zeigen die Komplexität der eindeutigen Identifikation von Risikopatienten am Beispiel dieser beiden, auf unterschiedlicher Grundlage basierenden Instrumente. Trotz des technischen Fortschritts sollte der Schwerpunkt der UAW-Vermeidung unverändert darauf liegen, Medikamente erst nach besonders gründlicher Prüfung der klinischen Indikation zu verordnen und eine adäquate Verlaufskontrolle zu gewährleisten. Die neuen CDSS oder Negativlisten bieten hierbei Unterstützung.

Due to the SARS CoV-2-virus (COVID-19), anxiety, distress, and insecurity occur more frequently. In particular, infected individuals, their relatives, and medical staff face an increased risk of high psychological distress as a result of the ongoing pandemic. Thus, structured psychosocial emergency concepts are needed. The University hospital of Essen has taken up this challenge by creating the PEC concept to reduce psychosocial long-term consequences for infected patients, relatives, and medical staff at the university hospital. The concept includes professional medical as well as psychological support to convey constructive coping strategies and the provision of adequate tools such as the low-threshold online training program (CoPE It), which is accessible via the webpage www.cope-corona.de.

The regular consumption of very small doses of psychedelic drugs (known as microdosing) has been a source of growing media and community attention in recent years. However, there is currently limited clinical and social research evidence on the potential role of microdosing as therapies for mental and substance use disorders. This paper examined subjective experiences of microdosing psychedelics to improve mental health or to cease or reduce substance use, and examined sociodemographic and other covariates of perceived improvements in mental health that individuals attributed to microdosing. An international online survey was conducted in 2018 and examined people’s experiences of using psychedelics for self-reported therapeutic or enhancement purposes. This paper focuses on 1102 respondents who reported current or past experience of psychedelic microdosing. Twenty-one percent of respondents reported primarily microdosing as a therapy for depression, 7% for anxiety, 9% for other mental disorders and 2% for substance use cessation or reduction. Forty-four percent of respondents perceived that their mental health was “much better” as a consequence of microdosing. In a multivariate analysis, perceived improvements in mental health from microdosing were associated with a range of variables including gender, education, microdosing duration and motivations, and recent use of larger psychedelic doses. Given the promising findings of clinical trials of standard psychedelic doses as mental health therapies, clinical microdosing research is needed to determine its potential role in psychiatric treatment, and ongoing social research to better understand the use of microdosing as self-managed mental health and substance use therapies.

The heterozygous human Klotho KL-VS haplotype has been associated with improved cognitive performance but results are inconsistent. Here we assessed Klotho KL-VS haplotype and cognition using data from the third examination of the population-based Heinz Nixdorf Recall Study. We analyzed cognition tests (immediate and delayed word list, Trail-Making Test [TMT] part A and B, Maze test, interference condition of the Stroop color-word test, verbal fluency) and their associations with Klotho KL-VS haplotype. The Klotho KL-VS haplotype is classified by the V-allele at SNP rs9536314 (F352V) and the S-allele at SNP rs9527025 (C370S). Heterozygotes for the KL-VS haplotype were compared with non-carriers. Analyses were performed in 1812 subjects (55–87 years). We found consistent but only slightly lower performance in heterozygous carriers of the KL-VS haplotype in all tasks with Z-scores ranging between Z = − 0.042 (verbal fluency) and − 0.17 (TMT part A). Differences between carriers and non-carriers were similar for men and women for all tests but TMT part B (interaction contrast = 8.4 s (95% CI − 2.3; 19.1)). While cognition declined with age, we found an effect modification by age (55–65 years, 66–75 years, > 75 years). In the 66–75 years KL-VS heterozygous age group, lower performance was seen in memory, visual attention and motor speed. Contrary to our hypothesis, heterozygous carriers of the KL-VS haplotype did not show enhanced performance in cognitive tests in our study.

One major concern of long-term opioid therapy (LTOT) for chronic noncancer pain (CNCP) is the risk of abuse of prescribed opioids.To examine the prevalence and predictors of opioid use-related hospitalizations and potential abuse of prescribed opioids by persons with LTOT for CNCP in a sample representative of the German statutory health insurance companies.Retrospective cross-sectional study in 2014. Anonymized German health claims database, including 4,028,618 insured individuals of 69 German statutory health insurances. Univariate logistic regression models to evaluate demographic and medical characteristics associated with hospital stays and a diagnosis of mental and behavioral disorders due to alcohol, opioids, tranquilizers, multiple substances and intoxications by narcotic agents in insured individuals with CNCP receiving LTOT.The prevalence of LTOT for CNCP was 0.8%; 9.9% of these insured individuals received high-dose LTOT (≥120 morphine equivalent mg/day). The 1‑year prevalence of hospital stays with a diagnosis of mental and behavioral disorders due to alcohol, opioids, tranquilizers, multiple substances and intoxications by narcotic agents was 1.75% of persons with LTOT. These diagnoses were strongly associated with prescriptions of tranquilizers (odds ratio [OR] 3.63; 95% confidence interval [CI] 3.03; 4.36) and moderately associated with diagnosis of depression (OR 2.52; 95% CI 2.12; 3.00) and slightly associated with diagnosis of somatoform pain disorder (OR 1.89; 95% CI 1.56; 2.28) and high-dose LTOT (OR 1.81; 95% CI 1.44; 2.27).The study is in line with the recommendations of the German national guidelines on long-term opioid therapy of chronic non-cancer pain (LONTS) to avoid concomitant prescription of tranquilizers for CNCP and to carefully select and monitor patients with depression and somatoform pain disorder.HINTERGRUND: Bedenken bezüglich einer Langzeitopioidtherapie (LTOT) bei chronischen nichttumorbedingten Schmerzen (CNCP) bestehen wegen des Risikos der missbräuchlichen Verwendung der verschriebenen Opioide.Feststellung der Prävalenz und Prädiktoren der Krankenhausaufenthalte von Personen mit einer Langzeitopioidtherapie wegen nichttumorbedingter Schmerzen und möglicher missbräuchlicher Verwendung von rezeptierten Opioiden in einer repräsentativen Stichprobe gesetzlich Krankenversicherter.Retrospektive Querschnittsstudie im Jahr 2014. Anonymisierte Routinedaten von 69 gesetzlichen Krankenversicherungen mit 4.028.618 Versicherten. Univariate logistische Regressionsanalysen, um demografische und medizinische Charakteristika zu identifizieren, die bei gesetzlich Krankenversicherten mit einer LTOT wegen CNCP mit einem Krankenhausaufenthalt und Diagnosen von psychischen und Verhaltensstörungen wegen Alkohol, Opioiden, Tranquilizern und multiplem Substanzgebrauch sowie Vergiftungen durch Betäubungsmittel assoziiert waren.Die Prävalenz der LTOT wegen CNCP war 0,8 %. 9,9 % dieser Versicherten erhielten eine Hochdosis-LTOT (≥120 mg Morphinäquivalent/Tag). Die 1‑Jahres-Prävalenz von Krankenhausaufenthalten mit Diagnosen von psychischen und Verhaltensstörungen wegen Alkohol, Opioiden, Tranquilizern und multiplem Substanzgebrauch und Vergiftungen durch Betäubungsmittel lag bei 1,75 % der Versicherten mit LTOT. Diese Diagnosen waren stark mit der Verschreibung von Tranquilizern (Odds Ratio [OR] 3,63; 95 %-Konfidenzintervall [KI] 3,03; 4,36) und mäßig mit Diagnosen depressiver Störungen (OR 2,52; 95 %-KI 2,12; 3,00) und leicht mit Diagnosen von somatoformer Schmerzstörung (OR 1,89; 95 %-KI 1,56; 2,28) und Hochdosis-LTOT (OR 1,81; 95 %-KI 1,44; 2,27) assoziiert.Die Studie unterstreicht Empfehlungen der Leitlinie LONTS, die gleichzeitige Verschreibung von Opioiden und Tranquilizern zu vermeiden und Patienten mit depressiver und somatoformer Schmerzstörung sorgfältig auszuwählen und zu überwachen.

Bedenken bezuglich einer Langzeitopioidtherapie (LTOT) bei chronischen nichttumorbedingten Schmerzen (CNCP) bestehen wegen des Risikos der missbrauchlichen Verwendung der verschriebenen Opioide. Feststellung der Pravalenz und Pradiktoren der Krankenhausaufenthalte von Personen mit einer Langzeitopioidtherapie wegen nichttumorbedingter Schmerzen und moglicher missbrauchlicher Verwendung von rezeptierten Opioiden in einer reprasentativen Stichprobe gesetzlich Krankenversicherter. Retrospektive Querschnittsstudie im Jahr 2014. Anonymisierte Routinedaten von 69 gesetzlichen Krankenversicherungen mit 4.028.618 Versicherten. Univariate logistische Regressionsanalysen, um demografische und medizinische Charakteristika zu identifizieren, die bei gesetzlich Krankenversicherten mit einer LTOT wegen CNCP mit einem Krankenhausaufenthalt und Diagnosen von psychischen und Verhaltensstorungen wegen Alkohol, Opioiden, Tranquilizern und multiplem Substanzgebrauch sowie Vergiftungen durch Betaubungsmittel assoziiert waren. Die Pravalenz der LTOT wegen CNCP war 0,8 %. 9,9 % dieser Versicherten erhielten eine Hochdosis-LTOT (≥120 mg Morphinaquivalent/Tag). Die 1‑Jahres-Pravalenz von Krankenhausaufenthalten mit Diagnosen von psychischen und Verhaltensstorungen wegen Alkohol, Opioiden, Tranquilizern und multiplem Substanzgebrauch und Vergiftungen durch Betaubungsmittel lag bei 1,75 % der Versicherten mit LTOT. Diese Diagnosen waren stark mit der Verschreibung von Tranquilizern (Odds Ratio [OR] 3,63; 95 %-Konfidenzintervall [KI] 3,03; 4,36) und masig mit Diagnosen depressiver Storungen (OR 2,52; 95 %-KI 2,12; 3,00) und leicht mit Diagnosen von somatoformer Schmerzstorung (OR 1,89; 95 %-KI 1,56; 2,28) und Hochdosis-LTOT (OR 1,81; 95 %-KI 1,44; 2,27) assoziiert. Die Studie unterstreicht Empfehlungen der Leitlinie LONTS, die gleichzeitige Verschreibung von Opioiden und Tranquilizern zu vermeiden und Patienten mit depressiver und somatoformer Schmerzstorung sorgfaltig auszuwahlen und zu uberwachen.

The original version of this article unfortunately contained a mistake. © 2019, Springer Nature Switzerland AG. Korrektur zu 10.1007/s40429-019-00249-z

Arbeitslosigkeit geht mit einem erhohten Risiko fur psychischen Distress und psychiatrische Storungen einher, die individuelles Leid und gesellschaftliche Kosten verursachen. Diese selektive Ubersicht stellt die Zusammenhange zwischen Arbeitslosigkeit und seelischem Befinden sowie psychiatrischen Storungen dar. Die wichtigsten Ansatze zur Verbesserung der psychischen Gesundheit Arbeitsloser werden skizziert

Die Unterbringung in einer Entziehungsanstalt geht in Deutschland mit einer hohen Erledigungsquote von um 50 % einher. In den Einrichtungen kommen konzeptionell ausgearbeitete psychotherapeutische Behandlungsformen zur Anwendung, jedoch in nur geringem Mas medikamentose Strategien, wie sie im offentlichen Gesundheitswesen Anwendung finden (z. B. eine Substitutionsbehandlung bei Opiatabhangigkeit). Der Beitrag stellt sinnvolle erganzende medikamentose Strategien fur den Einsatz im Masregelvollzug nach § 64 StGB dar.

Background Understanding the biological underpinnings of relapse in alcohol dependency is a major issue in addiction research. Based on recent evidence regarding the relevance of occipital visual evoked response potentials (ERPs) in addiction research, and its significance for relapse research, we assessed occipital ERPs to alcohol- and non-alcohol-related stimuli in recently detoxified patients and controls. Methods Thirty recently detoxified patients with alcohol addiction, and 31 healthy control subjects, were assessed in a Go and a NoGo condition, each using three visual stimuli: tea, juice and beer. In the “Go” condition, subjects had to respond to the juice (12.5 %) and the beer stimulus (12.5 %), and ignore the tea picture (75 %). In the “NoGo” condition, subjects had to respond to the tea picture (75 %) and ignore the juice and the beer picture (12.5 % each). The subjects’ EEGs were analyzed with regard to the occipital P100 and N170 ERP components. Patients were then evaluated for relapse 3 months after this initial assessment. Results P100 amplitudes differed between conditions and between stimuli, and we found a condition x electrode interaction. However, none of these P100 results involved group or relapse-status effects. N170 amplitudes in patients were elevated as compared to controls. Additionally, patients’ heightened N170 amplitudes in response to the alcohol-related (beer) stimulus were found only under the NoGo condition, where subjects had to react to the frequent tea stimulus and ignore the beer and the juice stimuli, thus resulting in a condition x stimulus x group interaction. Patients reporting relapse in a 3-month follow-up assessment showed larger NoGo N170 alcohol cue-related ERP amplitudes and increased depression scores as compared to patients who stayed abstinent. Depression was related to shortened P100 latencies in patients, but unrelated to the N170 NoGo cue-reactivity effect. Conclusions Our results indicate a sensitivity of occipital ERPs to addiction-related stimuli when these act as non-targets. Recently detoxified patients may be vulnerable to addiction-related cues when these occur outside the focus of directed attention, thereby circumventing intentional control processes. Furthermore, ERPs to addiction-related stimuli may be useful as a predictor of abstinence success in recently detoxified patients. Electronic supplementary material The online version of this article (doi:10.1186/s12888-016-0782-0) contains supplementary material, which is available to authorized users.

Diese Ubersichtsarbeit gibt einen zusammenfassenden Uberblick zur Epidemiologie des Drogenkonsums in der Bundesrepublik Deutschland inklusive dessen medizinischer und kriminologischer Folgeerscheinungen. Es finden die offiziellen Statistiken fur die Jahre 2007 und 2008 Berucksichtigung.

Die epidemiologisch belegte Zunahme cannabisbezogener Storungen fuhrt aktuell zur Etablierung entsprechender Therapieangebote. Uber die Inanspruchnahmepopulation ist wenig bekannt. Die Patienten einer neu etablierten Ambulanz zur Diagnostik und Behandlung cannabisbezogener Storungen wurden in Hinblick auf Konsummuster, Suchtmittelvorgeschichte und Vorbehandlungen, soziale Situation sowie Komorbiditat ausgewahlter psychischer Storungen unter Einsatz etablierter Erhebungsinstrumente (EuropASI, SKID-I) untersucht. Die 90 untersuchten Patienten (27,5±6,6 Jahre, 82% mannlich) berichteten uber eine Cannabiskonsumdauer von 11±7 Jahren bei einer aktuellen taglichen Konsummenge von durchschnittlich 1,9 g. 39% der Patienten lebten allein, 37% waren arbeitslos, etwa ein Viertel hatte juristische Probleme. Komorbide psychische Storungen (Achse I nach DSM-IV) wurden bei 42% der Patienten diagnostiziert. Im Gegensatz zu einem verharmlosenden Stereotyp wiesen Cannabisabhangige einer Spezialambulanz in einem erheblichen Ausmas einen chronifizierten Krankheitsverlauf mit assoziierten psychosozialen Problemen auf. In Analogie zur Behandlung anderer Substanzabhangigkeiten sind multidimensionale Therapien indiziert.

Frauen greifen eher zu den „weicheren“ Suchtstoffen wie Schmerzund Beruhigungsmitteln. Nicht selten nimmt die Abhangigkeit ihren Ausgang von einer arztlichen Verordnung und wird auch vom Hausarzt oft lange nicht bemerkt. Besonders problematisch wird eine Suchtkonstellation naturlich in Schwangerschaft und Stillzeit.

The aim of our study was to investigate antipsychotic treatment strategies in acute schizophrenic episodes in a German university hospital. Documented pharmacological procedures in the first six weeks of acute episodes of schizophrenia in the years 1998 (n = 108), 2001 (n = 92), and 2004 (n = 94) were analyzed. Inclusion criteria were: admission voluntary and involuntary as inpatient to our acute ward with a diagnosis of F20× according to ICD 10. Atypical antipsychotics (AAP) were significant more frequently used in the first week of treatment in 2001 and 2004 compared to the year 1998. Switching to AAP occurred significantly earlier in 2001 and 2004 (after 7,6 ± 7 days in 1998, 3,5 ± 5 days in 2001 and 2,3 ± 5 days in 2004; P

Maintenance treatment is now the most common treatment of opiate addicts in Germany. The principle of maintenance treatment is the administration of an opioid in order to suppress withdrawal symptoms and heroin craving. In this manner, maintenance treatment successfully reduces heroin abuse and directly associated risk behaviour. Only a minority of maintenance patients became opiate abstinent (including the maintenance drug). Racemic methadone is the most extensively evaluated maintenance drug. A differential indication between medical opioids has not been scientifically established. According to the German regulations psychosocial support is an obligatory part of maintenance treatment. Most opiate addicts suffer from comorbid mental and somatic diseases. Therefore psychiatric and somatic treatment is indicated and of proven value.

Angesichts drangender Probleme als Folge der Opiatabhangigkeit (z.B. erhohte Mortalitat, Gefahr der Ausbreitung der HIV-Infektion sowie von Hepatitis B und C, kriminelle Aktivitaten Abhangiger etc.) wird die arztliche Heroinverschreibung als erganzende Therapiestrategie diskutiert. Ob die genannten Probleme dadurch entscheidend beeinflusst werden, ist angesichts der geringen Zahl wissenschaftlicher Untersuchungen unklar. Die folgende medizinethische Analyse dient der Versachlichung der z. T. emotionalisierten Diskussion um die Heroinverschreibung. Als konsensfahige ethische Prinzipien arztlichen Handelns gelten hierbei die Verpflichtung auf das Patientenwohl, der Respekt vor der Patientenautonomie sowie die Verteilungsgerechtigkeit. Bei Anwendung dieser Prinzipien auf die Heroinverschreibung ergeben sich folgende Fragen: Dient die Heroinverschreibung primar dem Wohl des individuellen Patienten, oder handelt es sich um eine vornehmlich gesellschaftspolitische Masnahme? Ist die Einwilligungsfahigkeit bei Opiatabhangigen in Hinblick auf eine arztliche Heroinverschreibung eingeschrankt? Sind angesichts der knappen Ressourcen im Gesundheitssystem die Aufwendungen fur eine Heroinverschreibung im Vergleich zu den Aufwendungen fur andere Therapien fur Opiatabhangige, z. B. der Methadonsubstitution, zu rechtfertigen?

Methods: Twenty-two patients receiving (R)-methadone maintenance treatment were switched to a double dose of (R, S)-methadone: blood samples were collected before and after the change, and the concentrations of the enantiomers were measured. In the second period, during racemic methadone treatment, important interindividual variability in the stereoselective disposition of the enantiomers of methadone was measured, with (R)/(S) ratios ranging from 0.63 to 2.40. This point should be taken into account particularly with respect to therapeutic drug monitoring of racemic methadone. Results: A significant decrease P < 0.005 in the mean serum concentration/dose ratios of the active (R)-enantiomer before and after the change was measured (mean 3.97 and 3.33). Conclusion: Although of small amplitude (16%), this decrease confirms previously described adaptive changes in methadone pharmacokinetics during racemic methadone maintenance treatment and may necessitate, in some patients, a dose adjustment.

Background To assess comorbid DSM-IV-TR Axis I disorders in adolescent inpatients referred for treatment of substance use disorders. Methods 151 patients (mean age 16.95 years, SD = 1.76; range 13 - 22) were consecutively assessed with the Composite International Diagnostic Interview (CIDI) and standardized clinical questionnaires to assess mental disorders, symptom distress, psychosocial variables and detailed aspects of drug use. A consecutively referred subgroup of these 151 patients consisting of 65 underage patients (mean age 16.12, SD = 1.10; range 13 - 17) was additionally assessed with the modules for attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) using The Schedule for Affective Disorders and Schizophrenia for school-aged children (K-SADS-PL). Results 128 (84.8%) of the 151 patients were dependent on at least one substance, the remaining patients fulfilled diagnostic criteria for abuse only. 40.5% of the participants fulfilled criteria for at least one comorbid present Axis I disorder other than substance use disorders (67.7% in the subgroup additionally interviewed with the K-SADS-PL). High prevalences of present mood disorder (19.2%), somatoform disorders (9.3%), and anxiety disorders (22.5%) were found. The 37 female participants showed a significantly higher risk for lifetime comorbid disorders; the gender difference was significantly pronounced for anxiety and somatoform disorders. Data from the underage subgroup revealed a high prevalence for present CD (41.5%). 33% of the 106 patients (total group) who were within the mandatory school age had not attended school for at least a two-month period prior to admission. In addition, 51.4% had been temporarily expelled from school at least once. Conclusions The present data validates previous findings of high psychiatric comorbidity in adolescent patients with substance use disorders. The high rates of school refusal and conduct disorder indicate the severity of psychosocial impairment.

Background Recent epidemiological data show an increased trend of official estimates for syphilis infection in the general population. Many of the infected cases remain undetected leaving an underestimation of the true prevalence of syphilis in the general population, but also among subpopulations such as illicit drug users. There is limited epidemiological data published on the proportion and risk factors of syphilis infections associated with illicit drug abuse. Methods Illicit drug addicts (n = 1223) in inpatients units in Germany were screened (2000–01) for syphilis and interviewed regarding patterns of drug use and sexual behaviour. TPHA-test for initial screening and FTA-ABS-IgM test in TPHA-positive patients were used. Results In total, TPHA-tests were positive in 39 (3.3%) and 7 patients (0.6%) were IgM positive. The prevalence rate for syphilis in males was 1.9% and for women it was 8.5%. Female patients were 4.56 (CI 95% 2.37–8.78) times more likely to have a positive TPHA test than males. Sexual behaviours such as high number of sexual partners, sex for drugs/money, sex on the first day were associated with syphilis infection only in women. Females with frequent sex for drugs or money had 4.31 (CI 95% 2.32–8.52) times more likely a reactive TPHA test than remaining patients. Neither the sociodemographic factors nor sexual behaviour were statistically significant associated with syphilis infection among men at all. Conclusion Our data suggest the need for screening for syphilis among these illicit drug users in inpatient settings, in particular among sexual active women. This conclusion is corroborated by the finding of increasing numbers of syphilis infections in the general population. The identification of syphilis cases among drug addicts would give treatment options to these individuals and would help to reduce the spread of infection in this population, but also a spread into heterosexual populations related to prostitution.

Background Due to potential proarrhythmic side-effects levo-α-Acetylmethadol (LAAM) is currently not available in EU countries as maintenance drug in the treatment of opiate addiction. However, recent studies and meta-analyses underline the clinical advantages of LAAM with respect to the reduction of heroin use. Thus a reappraisal of LAAM has been demanded. The aim of the present study was to evaluate the relative impact of LAAM on QTc-interval, as a measure of pro-arrhythmic risk, in comparison to methadone, the current standard in substitution therapy. Methods ECG recordings were analysed within a randomized, controlled clinical trial evaluating the efficacy and tolerability of maintenance treatment with LAAM compared with racemic methadone. Recordings were done at two points: 1) during a run-in period with all patients on methadone and 2) 24 weeks after randomisation into methadone or LAAM treatment group. These ECG recordings were analysed with respect to QTc-values and QTc-dispersion. Mean values as well as individual changes compared to baseline parameters were evaluated. QTc-intervals were classified according to CPMP-guidelines. Results Complete ECG data sets could be obtained in 53 patients (31 LAAM-group, 22 methadone-group). No clinical cardiac complications were observed in either group. After 24 weeks, patients receiving LAAM showed a significant increase in QTc-interval (0.409 s ± 0.022 s versus 0.418 s ± 0.028 s, p = 0.046), whereas no significant changes could be observed in patients remaining on methadone. There was no statistically significant change in QTc-dispersion in either group. More patients with borderline prolonged and prolonged QTc-intervals were observed in the LAAM than in the methadone treatment group (n = 7 vs. n = 1; p = 0.1). Conclusions In this controlled trial LAAM induced QTc-prolongation in a higher degree than methadone. Given reports of severe arrhythmic events, careful ECG-monitoring is recommended under LAAM medication.