[French nationwide survey of abstinence-oriented treatments in opiate-addicted patients. Results at 12 months]. / Observatoire national des Traitements visant à l'Abstinence d'agonistes opiacés chez les patients Dépendants (OTAD). Résultats à 12 mois.

UNLABELLED: Over the last few years, general practitioners and pharmacists in France have become more directly involved in the treatment of opiate-addicted patients with the rapid development of office-based buprenorphine and methadone maintenance programs. At the same time, demand for abstinence-oriented interventions outside established maintenance programs continues to be addressed to the primary care system. METHOD: Our prospective and multicentric survey was conducted to monitor the follow-up of such abstinence-oriented interventions during a 12 months period, by means of questionnaires investigating the psychosocial, medical and addictive status of the patients recruited. RESULTS: One hundred and sixty five general practitioners have accepted to participate in the survey. Initially, they recruited 414 patients (51% terminating a buprenorphine maintenance treatment, 5% a methadone treatment and 36% withdrawing from heroin). Naltrexone chlorhydrate was prescribed for 50% early after entry in the survey. During the 12-month follow-up period: four data collections were proposed at 1, 3, 6, and 12 months. In all, data were collected for 158 patients. No data could be collected for 63 patients who were excluded from follow-up analysis. Out of the 351 patients who attended at least one follow-up visit, 137 (one third) moved to an opiate agonist maintenance program. When naltrexone was prescribed, total duration of treatment averaged 4785 days with no significant difference in terms of heroin relapse and attendance to follow-up visits. Between the first and the last data collection, out of the 113 HCV-positive patients, 13 received/started an anti-viral treatment. No significant difference was noted according to indicators of social outcome. CONCLUSION: Our survey shows that office-base abstinence-oriented interventions in opiate-addicted patients can produce a moderate benefit. Research concerning alternative formulations for opiate antagonists (e.g., long-acting naltrexone) could be helpfully in developing new options for treatment.

Economic and social effects of high-dose buprenorphine substitution therapy. Six-month results.

The purpose of this study was to analyze the impact of high-dose buprenorphine substitution therapy in opiate-dependent patients in terms of use of psychoactive substances, associated risks, social integration, and the social cost generated by the use of these substances. This was a longitudinal quantitative survey carried out in 1083 patients who were evaluated at three times: at the beginning of substitution therapy (D0), at 6 months and then at 12 months follow up (M6, M12). Data were collected with an anonymous self-administered questionnaire, completed in the presence of an investigating physician. Results demonstrated that patients treated with high-dose buprenorphine for 6 months, consumed fewer psychoactive drugs (heroin, cocaine, benzodiazepines) and had fewer associated risks. Additionally, several criteria involved in social integration showed improvement; morbidity and mortality decreased after the first 6 months of substitution therapy. These improvements were followed by a reduction in the social cost of drug use generated by the group of patients considered. These initial results require confirmation in the final analysis of the study taking into account the 12-month follow up.