Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients?
France was the first country to promote the extensive use of buprenorphine for the treatment of drug-addicted subjects through the primary care system. To assess both professional commitment and patients' characteristics, all the physicians and pharmacists of a French area having prescribed/dispensed buprenorphine from 2/12/96 (the official release date) to 1/31/98 were identified from data files of the Health Insurance and then interviewed. During the first 61 weeks of buprenorphine maintenance treatment (BMT), 27.5% of physicians and 51.2% of pharmacists of that area were involved; 142 patient records were documented. Features of the clinical routines spontaneously implemented for practice-based BMT were: a high level of on-site supervised dispensation by the pharmacist (71% at treatment induction and 23% thereafter); the absence of objective measurement of illicit drug use; and a low buprenorphine dosage. These features are consistent with the lack of physicians' experience and training, and also the relatively good status of the population treated (no HIV-positives, heroin use duration averaging 4.2 +/- 3.1 years, and 81.7% with stable accommodations). Despite liberal regulations guiding BMT, a negligible proportion of cases had a "nomadic" attitude (multiple buprenorphine prescribers/deliverers). The treatment outcomes (no deaths, three drug overdoses, improvement in occupational status) are encouraging.


CONCLUSIONS
Practice-based BMT appears to be a safe and acceptable response to moderate heroin addiction, but further training of the professionals involved and longitudinal investigations of individual outcomes are needed.
Vignau
J
J
University Hospital, Lille, France. jvignau@nordnet.fr
Duhamel
A
A
Catteau
J
J
Legal
G
G
Pho
A H
AH
Grailles
I
I
Beauvillain
J
J
Petit
P
P
Beauvillain
P
P
Parquet
P J
PJ
D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D017723:Drug Utilization Review; D005194:Family Practice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009313:National Health Programs / Q000331:legislation & jurisprudence; D017063:Outcome Assessment, Health Care; D010594:Pharmacies / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D009292:Narcotic Antagonists; D002047:Buprenorphine