title: [Reimbursement of opiate substitution drugs to militaries in 2007].
abstract: BACKGROUND
  The use of psychoactive drugs by militaries is not compatible with the analytical skills and self-control required by their jobs. Military physicians take this problem into consideration by organising systematic drugs screening in the French forces. However, for technical reasons, opiates are not concerned by this screening with the agreement of the people concerned. The estimated number of militaries who use an opiate substitute may be an approach of heroin consumption in the French forces. This study describes buprenorphine and methadone reimbursements made during 2007 by the national military healthcare centre to French militaries.
  
  
  METHODS
  Each French soldier is affiliated to a special health insurance. The national military healthcare centre has in its information system, all the data concerning drug reimbursement made to French military personnel. This is a retrospective study of buprenorphine and methadone reimbursements made during 2007 by the military healthcare centre, to militaries from the three sectors of the French forces, and from the gendarmerie and joint forces. Only one reimbursement of one of these two drugs during this period allowed the patient to be included in our study. Daily drug dose and treatment steadiness profile have been calculated according to the criteria of the French monitoring centre for drugs and drug addiction. The criteria of the National guidelines against frauds have been used to identify misuse of these drugs. Doctors' shopping behaviour has also been studied. Finally, the nature of the prescriber and the consumption of other drugs in combination with opiate substitute have been analysed.
  
  
  RESULTS
  One hundred and eighty-one military consumers of opiate substitute drugs (167 men and 14 women) participated. This sample included people from the three sectors of the French forces as well as from the gendarmerie and from the joint forces. The average age of the consumers was 26.6 years (20-42 years). The average length of service was 6.1 years (maximum 22 years service). One hundred and fifty-nine militaries had been delivered buprenorphine, 15 had been delivered methadone and seven had been delivered both. The prevalence of opiate substitute drug consumption by the militaries (52 per 100,000) is lower than in general population. According to the criteria of the National Healthcare Insurance, this population is not affected by abuse or fraud behaviour. Doctors' shopping behaviour is unusual. Opiate substitutes are prescribed by general physicians in 88% of issues. Only one prescriber was a military physician. An analysis of reimbursement of some drugs associated with opiate substitute has been made. The sampled military consume more psychoactive drugs (anxiolytics, antidepressants, hypnotics) than the French population under opiate substitution.
  
  
  CONCLUSIONS
  In our observation, the military physician is almost always excluded the process of substitution. His/her different responsibilities of care, but also in determining the working aptitude, lead to dissimulation behaviour by the militaries. The difficulty for military physicians is to identify such consumption. They have to evaluate the capacity to work through a physical and psychological examination.
authors.affiliation: Unité d'expertise en santé publique, département des services médicaux, Caisse nationale militaire de Sécurité sociale, Toulon cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: d'Argouges
authors.forename: G
authors.initials: G
authors.lastname: Desjeux
authors.forename: P
authors.initials: P
authors.lastname: Marsan
authors.forename: V
authors.initials: V
authors.lastname: Thevenin-Garron
mesh_terms: D002047:Buprenorphine / Q000191:economics* / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006556:Heroin Dependence / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008691:Methadone / Q000191:economics* / Q000627:therapeutic use*; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D009294:Narcotics / Q000191:economics* / Q000627:therapeutic use*; D009313:National Health Programs / Q000191:economics*; D058850:Opiate Substitution Treatment / Q000191:economics*; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000191:economics; D055815:Young Adult
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone