Exploring the Current State of Evidence of Homeopathic Interventions for Substance Abuse: A Scoping Review and Evidence Mapping

Abstract

Substance addiction poses a significant public health challenge globally, with diverse treatment approaches continually under exploration. Homeopathy, a complementary medical system, has gained attention for its potential role in managing substance addiction. However, the existing literature on homeopathic interventions in this context remains scattered and heterogeneous. The primary objective of this scoping review is to systematically assess and map the existing literature on homeopathic interventions for various types of substance addiction to understand the extent and nature of available evidence in the management of substance addiction disorders and highlight gaps that warrant further investigation. A systematic search was carried out in PubMed, Scopus, PsycINFO, Cochrane Library, and Complementary and Alternative Medicine-specific databases, using a predefined search strategy for studies published until December 2023, with a focus on various substance addictions and homeopathic interventions. Data extraction and synthesis involved categorizing key themes and summarizing findings to provide a systematic presentation of the literature. A total of 17 full-text articles were assessed for eligibility, resulting in a final sample of nine studies meeting predefined criteria. These studies, conducted between 1994 and 2021, varied in design, such as single-arm studies and randomized controlled trials. Key themes extracted from the studies included the types of substances addressed and homeopathic interventions employed. The synthesis revealed notable patterns and trends, including positive outcomes such as reductions in cravings and improvements in withdrawal symptoms across various substance addictions. The observed findings suggest a significant paucity and heterogeneity in the in the current state of evidence, thus highlighting, the need for more rigorous and standardized research in this field. This scoping review provides a comprehensive overview of the current evidence on homoeopathic interventions for substance addiction.

 

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Keywords

homeopathic treatment - substance addiction - disorders - scoping review - treatment approaches

Introduction

Substance addiction disorders constitute a formidable challenge to public health globally, affecting the emerging generations of many countries. This pressing issue reaches its peak among individuals aged 18 to 25 years, with the initiation of substance abuse as early as 12 years old.[1] The global landscape reflects a significant per capita alcohol consumption of 6.13 L, with European countries registering a notably higher average of 12.18 L.[2] Worldwide, more than a quarter (27%) of all 15 to 19-year-olds are current drinkers.[3] The alarming prevalence of substance abuse is underscored by an estimated 275 million people having used drugs in the previous year, with 31 million individuals grappling with drug abuse disorders in 2016.[1] The consequences of this epidemic are stark, with 4% of worldwide deaths and 4.5% of morbidity attributed to alcohol intake and drug use, resulting in approximately 450,000 deaths globally.[1] [2] The urgency of this issue is further emphasized by a nearly 21% increase in drug overdose-related deaths, reaching 63,632 in 2015 and 2016 alone.[1]

Clinically, substance addiction disorders are characterized as neuropsychiatric conditions marked by a recurring compulsive desire to consume substances despite known harmful consequences.[4] [5] While historical perspectives often viewed addiction through a moral lens, contemporary research has elucidated the neuroanatomical underpinnings involving structures like the orbitofrontal cortex and anterior cingulate gyrus, interconnected with limbic structures.[5] The clinical manifestation of substance addiction unfolds in a chronically relapsing cycle involving intoxication, bingeing, withdrawal, and craving—a cycle comprehensively explained by the “impaired response inhibition and salience attribution (i-RISA)” model.[5] [6] This model has gained wide acceptance in understanding various addictions, including nicotine, alcohol, and illicit drugs.

In the Diagnostic and Statistical Manual of Mental Disorders—V, the terminology has evolved from “substance dependence” to “drug addiction,” emphasizing the compulsive behavioral aspect over physiological reactions.[7] [8] “Tolerance,” defined as the need for increased drug amounts to achieve intoxication due to diminished effects, further highlights the complexity of these conditions.[9]

Homeopathy, founded by Samuel Hahnemann, offers a holistic approach to health care, focusing on the totality of symptoms.[10] Emphasizing mental and emotional aspects, homeopathy treats mental health conditions akin to physical ailments.[11] Despite gaining popularity, homeopathy faces scrutiny for its highly diluted, minimal dose approach and varying therapeutic efficacy. In the present substance abuse epidemic, special relevance lies in complementary therapies such as homeopathy. This scoping review aimed to meticulously explore and map the available evidence on the use of homeopathy in managing substance addiction disorders.

 

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Materials and Methods

The scoping review is conducted following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.[12]

Objective

• The primary objective of this scoping review is to systematically examine and map the existing literature on the use of homeopathy in the management of substance addiction disorders.

 

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Research Question

• What is the extent and nature of available evidence regarding the efficacy and outcomes of homeopathic interventions for various types of substance addiction?

 

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Literature Search

We employed a search strategy in PubMed, Scopus, PsycInfo, Cochrane Library, and Complementary and Alternative Medicine (CAM)-specific databases (Core-Hom and CAM-quest) to identify articles published till December, 2023. The search incorporated keywords and Medical Subject Headings (MeSH) terms related to homeopathy (“homeopathy,” “homeopathic treatment,” “homeopathic remedies”) and substance addiction (“substance addiction,” “substance abuse,” “drug addiction,” “alcohol dependence”, “Opioid”, “Alcohol”, “Tobacco”), using the AND operator to connect them. Also, hand search was conducted in the potentially relevant articles for additional relevant inclusion.

 

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Eligibility Criteria

We included studies that encompassed individuals of all ages and genders diagnosed with any substance addiction disorders (alcohol, opioids, or other substances). The focus of inclusion comprised homeopathic interventions for the management or treatment of substance addiction, which encompassed individualized remedies, combination remedies, or any other modalities within the homeopathic spectrum. A range of publication types, including peer-reviewed journal articles, conference proceedings, and gray literature such as reports and theses, published in the English language or those with available translations, were included for a comprehensive analysis.

Studies that investigated interventions not classified as homeopathic, publications without accessible full texts, literature in languages other than English without available translations, studies not done on humans, and in cases of duplicate publications reporting the same study, the most comprehensive or recent version was included to avoid redundancy.

Study Selection and Data Extraction

Two independent reviewers (AD and BB) conducted the initial screening based on the title and abstract. Full-text review was performed for potentially relevant articles, with any discrepancies resolved through discussion or consultation with a third reviewer.

A standardized data extraction form was developed to collect relevant information, including, authors, year of publication, country, study design, grade of evidence, sample characteristics, substance or condition studied, interventions or comparisons, follow-up duration, outcome measures, and key findings.

 

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Synthesis of Results

The extracted data were categorized and classified based on their relevance to the review questions and objectives. This involved grouping studies according to their study design (case series, cohort studies, and randomized controlled trials), intervention approaches (individualized homeopathy [IH], specific remedies, complex homeopathy, and isopathy), and outcomes assessed (withdrawal syndrome, addiction control etc.).The charted data were summarized in a coherent and structured manner to present an overview of the findings. This involved identifying patterns, trends, grade of evidence,[13] and commonalities across the included studies. Key findings, such as the effectiveness of homeopathy for addiction spectrum and frequently used homeopathic medicines, were highlighted and synthesized. The charted data were synthesized narratively, providing a written description and interpretation of the key findings. The results were discussed about the review questions and objectives, highlighting the implications and limitations of the included studies.

 

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Results

The initial search identified a total of 183 articles from various databases. After removing duplicates, the titles and abstracts of 49 articles were screened based on the predetermined inclusion and exclusion criteria. Subsequently, 17 full-text articles were assessed for eligibility.

The final sample for the scoping review comprised nine articles[14] [15] [16] [17] [18] [19] [20] [21] [22] that met the predefined criteria ([Fig. 1]). These articles encompass single-arm studies[14] [15] [17] [18] [21] and randomized controlled trials.[16] [19] [20] [22] The publication years of the included studies span from 1994 to 2021, reflecting a comprehensive temporal scope.

Fig. 1 Study selection process.

The data extracted from the included studies were categorized into key themes to facilitate a systematic presentation. The identified themes include types of substances addressed in the studies (e.g., alcohol, opioids, cocaine, tobacco, and multidrug) and types of homeopathic interventions employed (individualized, complex, isopathic, and specific). There were five studies that used IH,[15] [16] [18] [19] [22] and four studies used clinical/specific homeopathy.[14] [16] [17] [21] However, no study has reported isopathy or complex homeopathic interventions. The details of study characteristics are described in [Table 1], and the mapping of the number of studies as per types of addiction and types of homeopathy is plotted in [Fig. 2].

Table 1 Study characteristics

Author, Year	Country	Study design	Grade of evidence	Sample characteristics (sample size [age group])	Substance/condition studied	Type of homeopathy	Interventions	Comparison	Follow-up duration	Outcome measures	Key findings
Gopinadhan and Balachandran 1994[14]	India	Single arm, pre–post-comparison study	C	10 patients (30–62 y old)	Alcohol dependence	Specific	Arsenicum album in 30th and 200th potency	–	40 d	Qualitative assessment of desire for alcohol and improvement of associated signs and symptoms	All cases showed improvement.
Rai 1994[15]	India	Prospective, single-arm, pre–post-comparison study	C	261 patients (12–52 y old)	Multiple drugs (narcotic analgesics, mild tranquilizers, alcohol, cannabis, and multiple drugs) withdrawal syndrome	Individualized	Most commonly prescribed medicines were Rhus toxicodendron 30, 200, 1M,10M, 50M, Nux vomica 30, 200, 1M,10M, Avena sativa Q, Arsenicum album 30, 200, 10M, Chamomilla 200, 10M, Bryonia alba 200, 1M,10M, Kali phosphoricum 6x, Ipecacuanha 200, 1M, Cuprum metallicum 10M	–	Not mentioned	Qualitative assessment of symptomatology and improvement index	Homeopathic medicines showed improvement in the withdrawal symptoms of drug addicts.
Grover et al 2009[16]	India	Randomized placebo-controlled trial (double blind)	B	169 patients (15–50 y old)	Opium and its alkaloid derivatives withdrawal symptoms	Individualized	Six preselected homeopathic medicines (Arsenicum album, Nux vomica, Rhus toxicodendron, Pulsatilla, Ipecac, Chamomilla)	Placebo	30 d	Qualitative assessment of symptomatology (19 signs and symptoms)	Homeopathic medicine acted significantly better than the placebo group.
Adler et al 2012[17]	Brazil	Exploratory, prospective, single-arm trial	C	14 patients (18–65 y)	Alcohol dependence	Specific	Fifty millesimal potencies of Opium dispensed in sugar pills	–	7 wk	Units of daily alcohol consumption, SADD score	The specific intervention provided a significant reduction in daily alcohol intake and SADD score.
Nayak et al 2014[18]	India	Prospective, multicentric, single-arm trial	C	112 patients (15–50 y)	Acute alcohol withdrawal	Individualized	Most commonly prescribed medicines were Arsenicum album, Lycopodium clavatum, Belladonna, Nux vomica, Pulsatilla	–	6 mo	CIWA-Ar scale, WHO QOL Bref scale	IH showed a significant decrease in CIWA–Ar scores.
Manchanda et al 2016[19]	India	Randomized, controlled, comparative trial (open label)	B	80 (15–60 y)	Alcohol dependence	Individualized	.	Standard allopathic treatment	1 y	SADQ rating scale, WHO QOL Bref, management of detoxification, total number of drinking days, and number of drinks per drinking day	IH vs. SA did not show a significant difference in reducing SADQ score; the noninferiority relation of IH to SA in treatment outcome.
Adler et al 2018[20]	Brazil	Randomized, placebo-controlled, pilot trial (double-blind)	B	54 patients (18–65 y)	Cocaine dependence	Clinical	Psychosocial rehabilitation plus homeopathic Q-potencies of Opium and E. coca potencies	Psychosocial rehabilitation along with placebo	8 wk	Percentage of cocaine use in 56 d, Minnesota Cocaine Craving Scale, 12-point short-form health survey	Homeopathic medicines showed improvement compared to placebo in primary outcomes.
Shukla 2019[21]	India	Prospective, single-arm, study	C	30 patients (15–60 y)	Tobacco dependence	Specific	Plantago major 12C, 30C and 200C	–	Not defined	Fagerstrom tobacco nicotine dependence score	Pre- and postscores showed significant changes in the Fagestorm Nicotine Dependence Scores
Bomble et al 2021[22]	India	Randomized placebo-controlled trial (triple blind)	B	51 bus workers (19–55 y)	Tobacco dependence	Individualized	Nonnicotine replacement therapy (such as Tabacum, Avena Sativa, Nux Vomica, Staphysagria, Caladium) with behavioral therapy	Placebo with behavioral therapy	1 y	Fagestrom questionnaire, oral mucosal condition and location, Lobene stain index, community periodontal index, and loss of attachment using WHO oral health assessment form	Statistically significant difference was noticed where tobacco dependency and frequency of use of tobacco was concerned within the groups at the end of the 12th month. Intergroup differences were not insignificant

Abbreviations: CIWA-Ar, Clinical Institute Withdrawal Assessment for Alcohol scale; SADD, Short Alcohol Dependence Data score; SADQ, Severity of Alcohol Dependence Questionnaire; WHO QOL Bref, World Health Organization Quality of Life Brief Version.

Fig. 2 Evidence mapping of the included studies.

Mapping and synthesis of the data revealed notable patterns and trends in the existing literature on homeopathy for substance addiction. Commonly reported outcomes include key outcomes such as reduction in cravings and improvement in withdrawal symptoms, and homeopathic interventions demonstrated varying degrees of effectiveness across studies.

Despite the heterogeneity in study designs and outcomes, a comprehensive understanding of the current landscape of research on homeopathy for substance addiction emerged. The data synthesis also highlighted gaps in the literature, suggesting potential areas for future research and exploration.

Alcohol Withdrawal Syndrome

The single-group study conducted by Nayak et al[18] exclusively focused on acute alcohol withdrawal syndrome. This prospective, observational, exploratory, and multicentric trial scrutinized the impact of individualized homeopathic treatment on 112 subjects, tracked over 6 months. Outcome assessment measures comprised the Clinical Institute Withdrawal Assessment Scale of Alcohol-Revised (CIWA-Ar) and World Health Organization Quality of Life Brief Version (WHO QoL-Bref) scales. Most patients exhibited moderate-to-severe conditions at baseline according to the CIWA-Ar scale. Notably, both total and domain-specific CIWA-Ar scores in the sphere of agitation, anxiety, auditory hallucinations, clouding, headache, nausea and vomiting, paroxysmal sweating, tactile disturbances, tremors, visual disturbances, as well as the WHO QoL Bref scale, displayed statistically significant improvements. The most commonly prescribed medicines in this study were Arsenicum album, Lycopodium clavatum, Belladonna, Nux vomica, and Pulsatilla. Nevertheless, approximately 23.2% of patients experienced relapse within the initial 3 months of the study, with an additional 14.2% relapsing within the subsequent 6 months.

 

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Chronic Alcohol Dependence

In 1994, Gopinadhan and Balachandran[14] conducted a pilot study on 10 patients of chronic alcohol dependence to evaluate the effect of Arsenicum album. The study revealed a definite aversion to alcohol in eight cases and improvement in behavioral symptoms across all cases. Additionally, the study reported the maintenance of abstinence from alcohol in seven cases following discharge from the inpatient department.

Another exploratory single-arm study by Adler et al[17] explored the effect of 50 millesimal potencies of Opium on individuals dependent on alcohol. Participants, with an average of 15 years of alcohol dependence, underwent observation for 1 week, and medicine was administered between weeks 2 and 5. The study demonstrated a mean reduction of 29.37 units of alcohol consumption between weeks 1 and 5 and a significant statistical difference in the Short Alcohol Dependence Data score during the treatment phase with opium, but no significant difference was observed during the discontinuance phase. Five cases reported minor adverse events throughout the study, with one unrelated to the disease.

Manchanda et al[19] conducted an open-label randomized controlled trial comparing IH with the standard conventional treatment for alcohol dependence. Patients were screened through the Cutting down, Annoyance by criticism, Guilty feeling, and Eye-opener scale and International Classification of Diseases diagnostic criteria. Individualized homeopathic medicines were prescribed at the physician's discretion, while standard allopathic treatment involved chlordiazepoxide with thiamine for 10 to 14 days for detoxification, followed by baclofen, disulfiram, or risperidone. The primary endpoint aimed for a >50% reduction in the Severity of Alcohol Dependence Questionnaire after a 1-year treatment period. In the evenly distributed groups of 80 patients (IH and standard allopathic), the IH group showed a highly significant achievement of the primary endpoint by 80%, compared to 37.5% in the standard allopathic group. Over 12 months, 27.5% of IH patients maintained complete abstinence, compared to 17.5% in the standard conventional treatment group. The most commonly prescribed medicines were Sulphur, Lycopodium clavatum, Arsenicum album, Nux vomica, Phosphorus, and Lachesis. Significant differences were observed between the groups in the mean number of drinks per day and the physical, social, and environmental domains of the WHO-QoL Bref scale. However, no significance was noted in the relapse and psychological domains of the WHO QoL Bref in either group. A significant difference was found in the intensity of irritability and craving for alcohol between the two groups.

 

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Opioid Withdrawal Syndrome

Grover et al[16] conducted the sole double-blind placebo-controlled trial on opioid addiction, involving 169 patients. The study sought to evaluate the efficacy of homeopathic medicines in managing opioid addiction, employing six predefined remedies (Arsenic album, Nux Vomica, Rhus Toxicodendron, Pulsatilla Nigricans, Ipecacuanha, and Chamomilla) in an individualized approach. Although participants were followed up for 30 days, data analysis occurred only at the end of the third day. The study did not utilize specific scales as outcome assessors; instead, it relied on a comparative analysis of symptoms between the homeopathy and placebo groups. The findings revealed a significant improvement in homeopathy compared to the placebo group in managing opioid withdrawal symptoms, including “lachrymation,” “sneezing,” “yawning,” “abdominal pain,” “constipation,” and “irritability.”

 

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Cocaine Addiction

In a double-blind randomized controlled trial conducted by Adler et al,[20] 50 millesimal potencies (Q1 to Q5) of Opium and E. Coca were administered alongside the standard care provided at the center. The final analysis of 54 patients revealed a lower percentage of cocaine-using days in the homeopathy group compared to the placebo group although there was no discernible difference in the intensity of craving measured through the Minnesota Cocaine Craving Scale. A notable occurrence of an entire week without craving was more frequent in the homeopathy group during weeks 4 to 6. Quality-of-life assessment showed no significant difference, except in a β regression model where physical scores were significantly higher in the homeopathy group. The incidence of adverse events was lower in the homeopathy group compared to the placebo group, with a total of 34 adverse events reported, including one death in the placebo group.

 

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Tobacco Dependence

Two studies[21] [22] demonstrated the effect of homeopathy on tobacco dependence. The first study conducted by Shukla[21] was a prospective single-arm pre–post-analysis of 30 cases. Fragestrom tobacco nicotine dependence score showed a significant difference in pre–post-values using homeopathic medicine Plantago major though any fixed follow-up interval was not defined within the study. The study conducted by Bomble et al[22] was a triple-blind parallel arm placebo-controlled randomized controlled trial which evaluated the efficacy of homeopathy in tobacco dependence of bus workers. The study demonstrated significant statistical differences in tobacco dependency scores and frequency of use of tobacco within the groups at the end of 12 months. No statistically significant difference was observed when compared with placebo.

 

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Multiple Drug Addiction Withdrawal Syndrome

Rai[15] conducted a study to investigate the impact of individualized homeopathic medicines on withdrawal symptoms associated with multidrug addiction, encompassing substances like narcotic analgesics, mild tranquilizers, alcohol, cannabis, and various drugs. The results indicated a notable 86.7% (209/241) improvement following treatment, with Rhus Toxicodendron, Avena Sativa, Nux vomica, and Arsenicum album emerging as the most frequently indicated remedies. Additionally, 10M potencies of Rhus Toxicodendron, Arsenicum album, and Chamomilla were identified as particularly effective in the treatment of withdrawal symptoms.

 

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Discussion

The scoping review aimed to systematically examine and map the existing literature on the use of homeopathy in the management of substance addiction disorders. The synthesis of data revealed diverse studies with varying designs and outcomes, contributing to a comprehensive understanding of the current landscape of research in this field.

The findings suggest varying degrees of effectiveness of homeopathic interventions across different substance addictions. In alcohol withdrawal syndrome, Nayak et al's study demonstrated statistically significant improvements in withdrawal symptoms and quality of life.[18] Similarly, studies on chronic alcohol dependence showed positive outcomes, with notable cases reporting aversion to alcohol and maintenance of abstinence.[14] The exploration of Opium and other homeopathic medicines in alcohol dependence studies also presented promising results.[17] [19] In opioid addiction, the double-blind placebo-controlled trial by Grover et al[16] highlighted the efficacy of homeopathic medicines in managing withdrawal symptoms, showcasing significant improvements compared to a placebo. Furthermore, in cocaine addiction, homeopathic treatments demonstrated a lower percentage of cocaine-using days and a notable occurrence of weeks without craving.[20]

Studies on tobacco dependence demonstrated improvement in tobacco dependency scores and frequency of use through homeopathy.[21] [22] The investigation into multiple drug addiction withdrawal syndrome revealed an 86.7% improvement following treatment.[15]

While the findings provide insights into the potential benefits of homeopathy for substance addiction, it is essential to acknowledge the heterogeneity in study designs, outcomes, and the extremely limited number of studies in substance categories. The grade of evidence in the studies is mostly limited to “B” and “C,” and there is a significant lack in the number of trials for different types of homeopathy on specific types of addiction. Moreover, we did not find any grade ‘A’ evidence, such as systematic reviews or RCTs with narrow confidence intervals (CIs), as all the RCTS had low sample sizes and/or wide CIs. Therefore, it is quite clear that the evidence for the use of homeopathy for varying degrees of addiction is limited.

The primary limitation of this scoping review lies in the absence of a quality assessment of the included studies. This limitation introduces the potential for bias, wherein recommendations or syntheses derived from the review may rely on varying levels of evidence and quality within the cited literature. Consequently, scoping reviews are generally not considered definitive sources for practice guidelines or policy decisions due to the absence of a quality assessment. Instead, they are conducted primarily to identify and map the breadth, rather than the quality, of the current literature in a research area with broad clinical relevance and diverse research directions.

It may be noted that this scoping review was conducted with a rigorous and transparent methodology akin to more focused systematic literature reviews, enhancing its credibility. The ongoing, iterative collaboration with research users also contributes to the strength of this scoping review. The inclusion of studies published only in English may introduce language bias. The diversity in study designs and outcome measures makes direct comparisons challenging. Additionally, the reliance on available translations for non-English literature may impact the comprehensiveness of the review.

The review identified gaps in the literature, emphasizing the need for more research to strengthen the evidence base. Future studies should aim for standardized methodologies, larger sample sizes, and consistent therapeutic strategies and outcome measures to facilitate more robust comparisons and generalizations.

 

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Conclusion

This scoping review provides a comprehensive overview of the current state of evidence on homeopathic interventions for substance addiction. The findings suggest potential benefits in various addiction categories, but the heterogeneity and limited number of studies highlight the need for more rigorous research. The identified gaps in the literature serve as a call to action for researchers to address key questions and further explore the role of homeopathy in substance addiction management.

This review contributes to the broader understanding of homeopathy's potential in addressing substance addiction and provides a foundation for future clinical trials. This groundwork will facilitate the conduct of systematic reviews and meta-analyses focused on specific topics within this evolving field.

 

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Conflict of Interest

None declared.

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Publikationsverlauf

Artikel online veröffentlicht:
05. September 2024