French general practitioners' prescribing high-dosage buprenorphine maintenance treatment: is the existing training (good) enough?
In France, since 1996, any general practitioner (GP) can prescribe high-dosage buprenorphine maintenance treatment (BMT) for opioid-dependent patients. The health authorities initially provided mandatory specific training, but since 1998, such training is only delivered by specialized networks and the pharmaceutical industry. Among a random sample of GPs from southeastern France (N=345), we found that many untrained GPs, as well as a significant minority of trained GPs, were likely to prescribe an ineffective dosage of buprenorphine or a potentially dangerous treatment (BMT+a short half-life benzodiazepine). These results highlight the necessity to edit clear guidelines, especially concerning situations of polyaddiction and psychiatric comorbidity, and to extend and improve BMT training in France with a renewed involvement of health authorities for quality control of such training. They even suggest that GPs' participation to specialized training sessions should become a mandatory prerequisite for prescribing BMT.
Feroni
Isabelle
I
Institut National de la Recherche Médicale, U 379, 23 Rue Stanislas Torrents, 13006 Marseilles, France.
Peretti-Watel
Patrick
P
Masut
Alain
A
Coudert
Christine
C
Paraponaris
Alain
A
Obadia
Yolande
Y
D000328:Adult; D001291:Attitude of Health Personnel; D002047:Buprenorphine / Q000008:administration & dosage*; D011307:Drug Prescriptions / Q000592:standards; D004502:Education, Medical, Continuing / Q000592:standards*; D005194:Family Practice / Q000193:education*; D005260:Female; D005602:France; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010821:Physicians, Family / Q000523:psychology; D017410:Practice Guidelines as Topic; D017450:Receptors, Opioid, mu / Q000819:agonists; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy; D011795:Surveys and Questionnaires
D017450:Receptors, Opioid, mu; D002047:Buprenorphine