[Risk factors of early drop-out during induction of high-dose buprenorphine substitution therapy. A study of 1085 opiate addicts]. / Facteurs de risques de rupture précoce de prise en charge lors de l'induction d'un traitement substitutif par buprénorphine haut dosage. Etude chez 1085 dependants aux opiacés.

BACKGROUND: The revelation of an acceptable rate of users still treated one year after initiation of a substitution program with high-dose buprenorphine (HDB) has contributed in the validation of the interest of the molecule in this indication. However the frequency of early drop-outs (after the first consultation), when treatment is set-up, is frequently evoked, although undocumented, by general practitioners. OBJECTIVE: During analysis of a survey on the follow-up of opiate addicts starting substitution therapy with HDB, we attempted to assess the frequency of early drop-outs and identify the contributing factors. METHOD: Among the 1085 patients included in the study and in whom induction therapy had been prescribed, 656 were assessed after 12 months' follow-up. RESULTS: Age, precariousness, lack of social support and partial access to care (lack of health insurance, previous contact with the prescriber) were significantly associated with early drop-out. The consumption of psychoactive products and their administration mode, during the 30 days prior to the first consultation of those loss to follow-up, also differed from those of patients who remained within the care system. CONCLUSION: Knowledge of the factors related to frequent early drop-out during induction of HDB substitution therapy, and bearing this in mind, would permit the organisation of more attentive management and hence reduce the drop-out rate.