[Experiences with levomethadone substitution in AIDS patients with intravenous drug dependence]

LMS of heroin addicts with AIDS is to be seen first of all as a part of AIDS prevention, secondly as an individual help for these very ill patients. The legal basis for North-Rhine Westphalia is described. In the district of Recklinghausen the Public Health Office developed a procedure for the LMS according to existing rules of the district of Unna and summarized it in 12 points after discussions with the Department of Public Prosecution. It contains procedural rules such as establishing the indication, agreement between doctor and patient, psychosocial care, prescription for levomethadone, urine analysis for control of other additional abuse, notice to the Public Health Commissioner, and a working group between all involved parties. In the district of Recklinghausen we have experiences with 14 IV-drug addicts infected with AIDS who receive or received levomethadone. Up to now we observe mostly positive experiences concerning social reintegration and the reduction of crime incidence among these people. It is most important that patients can be stabilized to be able to undergo AIDS specific therapy or prophylactic medication against opportunistic infections.