[Reduction in the number of lethal heroin overdoses in France since 1994. Focus on substitution treatments]. / Diminution du nombre de surdoses mortelles à l'héroïne, en France, depuis 1994. A propos du rôle des traitements de substitution.

BACKGROUND: Since 1994-1995, rapid development of widely available substitution treatments has appeared to be a major healthcare step in heroin addiction. Currently approximately 60000 patients are taking daily maintenance doses of oral methadone and about 7200 are taking sublingual buprenorphine. In parallel with the expansion of these treatments, the number of lethal overdoses has fallen off regularly: 564 in 1994, 393 in 1996 and 143 in 1998 (-74.6% in 4 years). AIM OF THE STUDY: We searched for a correlation between the rise in the number of patients taking maintenance treatments and the decreased in recorded deaths due to heroin overdose. Other factors which may influence this decrease were also considered. RESULTS AND DISCUSSION: A linear correlation was found between the increasing number of patients on maintenance treatment (high-dose buprenorphine or methadone) and the decrease in fatal heroin overdoses in France between 1994 and 1998. The importance of this correlation must be modulated by the presence of other events such as political, social, healthcare and behavioral events concerning drug users.

[Withdrawal syndromes of newborns of pregnant drug abusers maintained under methadone or high-dose buprenorphine: 246 cases]. / Syndromes de sevrage des nouveau-nés de mères toxicomanes substituées par la méthadone ou la buprénorphine haut dosage.

UNLABELLED: Perinatal prognosis of pregnant drug abusers is better with intensive prenatal care and substitution maintenance programs. There is a large body of data in the literature on methadone (MTD), but very little on high-dose buprenorphine (HDB). The objective of this study was to compare 2 groups of pregnant women maintained on MTD or HDB for perinatal events. STUDY DESIGN: Prospective multicentric study; all neonates (NN) whose mothers has been maintained during pregnancy on MTD or HDB were included by 34 French perinatal centers with specialized staff for care of these pregnant drug abusers. RESULTS: Two hundred and forty-six pregnant women were included: 93 (38%) MTD and 153 (62%) HDB. Social and perinatal data, prenatal care and factors correlated with poor prenatal care are reported. Forty-six percent of the pregnant women had good prenatal care; 88% had peridural analgesia; mean birthweight=2838g; mean gestational age=38.7 weeks; prematurity<37 weeks=13; intra-uterine growth retardation=32%. Sixty-five percent neonates had withdrawal neonatal syndrome (WNNS) at a mean age of beginning at H40, mean highest Lipsitz score was 8.2 at H78. Half of the neonates with WNNS received treatment, mainly with morphine chlorhydrate. Neonatal mortality was 0/246. Discharge of the neonates was 60% with their father and their mother, and 32% with their mother alone; 4% were placed in foster homes by judicial decision. The only statistically significant differences between the MTD and HDB groups were: maintenance program was more frequently initiated before this pregnancy for the HDB vs MTD group (p<0.03); MTD maintenance was more often supervised by maintenance specialized centers and HDB by general practitioners (p<0.001); prematurity was 18% for MTD group vs 9% for HDB group (p<0.04); mean age of maximum Lipsitz score was H92 for MTD group vs H70 for HDB group (p<0.001). CONCLUSIONS: The perinatal medical and social prognosis of these 246 pregnant drug abusers and of their neonates appeared to be improved by the specialized prenatal care, comparatively with literature data. Perinatal impact of substitution program during pregnancy would be similar with MTD or HDB.

[The Rorschach's test for heroin addicts treated by methadone: from reality to imaginary]. / Le test de Rorschach chez des héroïnomanes traités par la méthadone: de la réalité à l'imaginaire.

The aim of this study was to analyze the role of the imaginary and its link with reality among 30 subjects treated by methadone. The Rorschach test was proposed to 30 heroin addicts treated by methadone, over an average 7 months. The formal answers (used preferentially in the 30 results, though often inappropriately) and socializing landmarks involving considerable individual investment, we were able to identify two ways of working within the same protocol. The first relies most on conformity and adaptation and tries to put the imaginary aside. The second is a more projective, unorganized approach evidencing the influence of the imaginary. This specific imaginary activity could not be assimilated with the traditional "lack of fantasy" observed in heroin addicts. It would be interesting to examine the course of this approach over a longer period.

[Physical and sports activities in the history of patients treated for addictions. Report 1999 of the study sponsored by the Ministry of Youth and Sports (France)]. / Activités physiques et sportives dans les antécédents des personnes prises en charge pour addictions. Rapport 1999 de l'étude commanditée par le ministère de la Jeunesse et des Sports (France).

Early February 1999, the French Ministère de la Jeunesse et des Sports (Youth and Sports Ministry) sponsored three different studies, aiming to prevent harmful behavior in the area of sport practices among youth. Two years earlier, our health care team working with drug users published reports on the meaningfulness of intensive sports activities in the history of our patients. The present work was performed to highlight the midterm results of one of these studies, to better understand and quantify the importance of physical training in the history of a group of outpatients seen for addictive disorders and comorbid pathologies. For 20 consecutive weeks, 3,040 self-administered questionnaires were available for persons consulting 20 health centers, 2 self-help groups and a general practitioner network working in the field of alcohol or heroine abuse. One thousand one hundred and eleven questionnaires were filled out (36.1%) and returned by mail for complete analysis: 86% of the answering persons had practiced at least one sports activity or participated in physical training, 10.5% had participated in a national or international level competition, and 10.6% reported stress fractures. In the intensive sports group, 36% had used illicit drugs intravenously and 16.4% said they had already used doping substances. Only 28.4% said they experienced dependence during their period of intensive sports activities compared with 15.2% before this time, and a majority (56.4%) thereafter. Intensive sports or physical training should not be seen as a protective factor nor as a way of improving addictive behaviors. More studies are needed to evaluate individual vulnerability factors and specific harm of overtraining and to determine the exact periods when men and women participating in sports activities are likely to abuse drugs, especially at the end of their career.

Relevance of urinalysis monitoring of methadone maintenance patients: a clinical-biological agreement on 41 patients.

Abstract This study evaluated the concordance of concomitant urinalysis and clinical assessments of drug abusers included in a methadone maintenance programme. The agreement between a clinical subjective score and an objective biological score, both measuring the evolution of illicit substance consumption over 12 months, was analysed. The clinical score, established by physicians and applied during patient interviews, was determined at entry into the programme and re-evaluated after 6 and 12 months. Forty-one patients were evaluated. The urinalysis score was based on regular screening of urine samples with the EMIT method. Agreement between the two scores was determined by using the kappa coefficient for each substance (opiates, benzodiazepines and cocaine) for each time-point. The calculated kappa coefficients showed poor agreement between the two scores, but could indicate the complementarity of these clinical and biological appraisals. Indeed, the urinalysis objectively detected change in drug use before the clinician. Thus, urinalysis monitoring should be considered as an additional and complementary biological procedure for patient follow-up by physicians.

[Withdrawal syndrome in 2 drug addicts after intravenous injection of buprenorphine?]. / Syndrome de manque chez deux toxicomanes après injection intraveineuse de buprénorphine?

Adequate dosage of sublingual buprenorphine is now recommended for substitution treatment of severe opioid dependance. We report two cases of acute discomfort, probably linked to withdrawal syndrome, after an IV injection of high doses of buprenorphine in opiate dependant patients. Data on the pharmacokinetics and neurobiochemical aspects of buprenorphine are compared with those of other opiates. A major issue of this work is a guideline for inducing substitution treatment with this "unique" partial agonist/antagonist of endorphinic receptors.