Evaluation of buprenorphine maintenance treatment in a French cohort of HIV-infected injecting drug users.
BACKGROUND
Buprenorphine was approved in France for treating opiate dependence in July 1995 and can be prescribed by general practitioners (GPs). Most studies assessing buprenorphine maintenance treatment (BMT) outcomes have taken place in GP settings. An evaluation of BMT outcomes in patients already followed for their HIV-infection could supply additional information about the changes in addictive practices in a non-GP setting.


METHODS
We assessed BMT discontinuations and the course of self-reported addictive behaviours and characteristics associated with buprenorphine-injection misuse in 114 HIV-infected patients on BMT who were followed in a hospital-based outpatient department.


RESULTS
The continuous series of follow-up visits at which these 114 patients reported regular buprenorphine prescriptions accounted for 237.5 person-years of observation, i.e. 475 follow-up visits. Of the 114 patients on BMT, 43% continued BMT throughout the follow-up, 40% stopped it, and results for 17% were not available either because they did not answer the self-administered questionnaire (5%) or because they were lost to follow-up (12%). Addictive behaviours declined but buprenorphine injection misuse remained stable. Depression measured by the CESD score (RR=1.04 95%CI [1.01-1.06]), cocaine use (RR=2.48 95%CI [1.31-4.68]) and alcohol consumption exceeding 4 alcohol units (AU) per day (RR=2.29, 95%CI [1.17-4.46]) were independently associated with buprenorphine injection misuse among stabilised BMT patients.


CONCLUSIONS
Despite the reduction in drug injection after starting BMT, buprenorphine injection misuse mainly involves patients with characteristics of severe addiction. Better monitoring of the illicit drug use patterns of patients on BMT may suggest new medical strategies for GPs to improve BMT outcomes.
Carrieri
Maria-Patrizia
MP
ORS PACA-INSERM research Unit 379 'Epidemiology and Social Sciences Applied to Medical Innovation, Institut Paoli Calmettes, 23 Rue S Torrents, 13006 Marseille, France. pmcarrieri@aol.com
Rey
D
D
Loundou
A
A
Lepeu
G
G
Sobel
A
A
Obadia
Y
Y
D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000150:complications* / Q000523:psychology; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D012720:Severity of Illness Index; D015819:Substance Abuse, Intravenous / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000706:statistics & numerical data*
D009292:Narcotic Antagonists; D002047:Buprenorphine