Substitution therapy

A Substitution therapy may be necessary in some cases to ensure the functioning of the body and all of its organs. The body is supplied with missing substances that it needs to function properly. In such cases, one speaks of substitution therapy.

What is substitution therapy?

A Substitution therapy is defined by the fact that the body is supplied with substances from outside that it normally produces itself. However, a functional weakness or failure of the respective organ can mean that this is no longer possible.

A special form of substitution therapy is the therapy of opioid addicts, who are given methadone or similar agents, for example, to curb withdrawal symptoms and thus release them from the orbit of addiction. The aim is to get over the side effects of drug addiction.

Function, effect & goals

There are different areas of application and application methods for a Substitution therapy. A classic area of ​​application is the addition of insulin in diabetes mellitus, when the pancreas is no longer able to provide sufficient insulin for sugar regulation in the body.

The person concerned injects insulin into the abdominal area. Other forms of substitution therapy are levothyroxine administration for hypothyroidism (hormone supplementation after thyroid surgery), enzyme replacement therapy for certain metabolic disorders, blood transfusion for anemia or volume replacement for dehydration.

Substitution therapy is often indicated, especially after operations. In addition to insulin replacement therapy, levothyroxine administration in hypothyroidism is one of the most frequently indicated replacement therapies in practice.

Substitution therapy for drug addiction is one of the best-known substitution therapies that also has a social function. With methadone substitution, the addict is given a daily dose of methadone appropriate to the level of addiction in order to avoid withdrawal symptoms. The methadone is slowly tapered until there is no longer any dependency, because methadone also has a high potential for addiction.

The aim of all substitution procedures is that the body or the damaged organs can resume their normal function. When administered, the added substation docks onto the responsible receptors and thus ensures normal functioning. In the case of heroin addicts, for example, the aim is to get rid of the addictive substance and thus exclude possible psychosocial and health consequences.

Ideally, the aim is to restore the ability to work and to avoid crime with acquisitions. Infection with diseases typical of drug use, such as hepatitis C, is also one of the goals. Experience has shown that the principle works and that addicts can actually be removed from the cycle of addiction, drug-related crime and deterioration in health, particularly with substitution therapy for addictive diseases.

Since the “substance” from the street is too often too impure or too pure, methadone substitution can also prevent those affected from overdosing or being poisoned.

Risks, side effects & dangers

But one Substitution therapy also carries risks. When injecting insulin, for example, it is important to ensure that the correct dose is injected, as otherwise dangerous hypoglycaemia can occur. If the injected insulin dose is too low, the sugar remains too high, which can also lead to severe symptoms.

When levothyroxine is administered in hypothyroidism, it is also important that the necessary hormones are added to the thyroid and parathyroid glands in a professional manner and in the correct dosage in order to avoid complications. The same applies to blood transfusions, enzyme replacement therapy and volume replacement in the case of dehydration. It is important to take exactly the right dose and to administer it properly. Otherwise the most severe side effects can occur.

Substitution therapy should therefore always be carried out by specialists and with the patient under observation. Often there are also complications in the transition between inpatient care and outpatient follow-up care. Another stumbling block is when different medical disciplines (surgery, general medicine and internal medicine) are involved, because smooth interaction must then be guaranteed. In the case of drug substitution, there is also the necessary psychosocial care in order to counter the risk of relapse through psychotherapy.