French Field Experience with Buprenorphine
Am J Addict. 2004-01-01; 13(s1): S17-S28
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1. Am J Addict. 2004;13 Suppl 1:S17-28.
French field experience with buprenorphine.
Auriacombe M(1), Fatséas M, Dubernet J, Daulouède JP, Tignol J.
(1)Department of Psychiatry and Addiction, Victor Pachon Medical School,
Université Victor Segalen Bordeaux 2, Bordeaux, France.
In most European countries, methadone treatment is provided to only 20-30% of
opiate abusers who need treatment due to regulations and concerns about safety.
To address this need in France, all registered medical doctors since 1995 have
been allowed to prescribe buprenorphine (BUP) without any special education or
licensing. This led to treating approximately 65,000 patients per year with BUP,
about ten times more than with more restrictive methadone policies. French
physician compensation mechanisms, pharmacy services, and medical insurance
funding all minimized barriers to BUP treatment. About 20% of all physicians in
France are using BUP to treat about half of the estimated 150,000 problem heroin
users. Daily supervised dosing by a pharmacist for the first six months resulted
in significantly better treatment retention (80% vs 46%) and lower heroin use.
Intravenous diversion of BUP may occur in up to 20% of BUP patients and has led
to various infections and relatively rare overdoses in combination with
sedatives. Opiate overdose deaths have declined substantially (by 79%) since BUP
was introduced in 1995. Newborn opiate withdrawal in mothers treated with
buprenorphine compared to methadone was reported to be less frequent, less
severe, and of shorter duration. Although some of the public health benefits seen
during the time of buprenorphine expansion in France might be contingent upon
characteristics of the French health and social services system, the French model
raises questions about the value of tight regulations on prescribing BUP imposed
by many countries throughout the world.
PMID: 15204673 [Indexed for MEDLINE]