Comparison of high dose buprenorphine treatments of opiate dependent outpatients in four healthcare networks.
OBJECTIVE
The aim of this study was to compare the various clinical practices in four health care networks and to access how the variations in treatment effected the outcome in opiate-dependent patients.


METHODS
A retrospective study was carried out with 71 participating general practitioners. These were chosen from a group of 354 practitioners from four health care networks. Each practitioner could enroll up to 5 patients who were currently undergoing treatment with high-dose buprenorphine(HDB). The patients treatment had to have been initiated between the 1(st) of February 1996 and the 31(st) of October 1996, and excluded any patients who had lapsed on their treatment during the first month. Patients were selected until a total of 75 cases were enrolled from each network. Data were then collected retrospectively between June and December 1997. Information collected concerned the initial stage of treatment, the stabilizing stage or level of treatment and followed up data on the most recent prescriptions.


RESULTS
The final patient maintenance totals were high for all four care networks (82.7 to 96% of patients were still being followed by their doctor at the final evaluation). A positive outcome as indicated by reduction of risk and decreased social vulnerability was also observed in all networks. Additionally, in each network there was a clear correlation between prescription practices and patient behavior. For example, the prescription of HDB at a daily dose of less than 6.2mg was associated with a higher rate of benzodiazepine use; and prescription of several daily doses of HDB was associated with a higher percentage of injecting patients.


CONCLUSIONS
This retrospective study provides evidence that general practitioner care of drug-dependent patients as outpatients, within a health care network helps to stabilize patient visits, allows treatment of associated comorbidities and favors social rehabilitation. The prescription of HDB as a single daily dose, individually adapted for each patient, optimizes the outcome and reduces misuse.
De Ducla
M
M
Réseau Renapsud, 2 place Louis-Barthou, 33000 Bordeaux.
Gagnon
A
A
Mucchielli
A
A
Robinet
S
S
Vellay
A
A
D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D003061:Codeine; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006296:Health Services; D006556:Heroin Dependence / Q000188:drug therapy; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D012309:Risk-Taking; D013997:Time Factors; D016896:Treatment Outcome
D009292:Narcotic Antagonists; D002047:Buprenorphine; D003061:Codeine