Duburcq A, Charpak Y, Blin P, Madec L
EVAL, 43, boulevard du Maréchal Joffre, 92340 Bourg-la-Reine, France.
Rev Epidemiol Sante Publique. 2000 Aug;48(4):363-73.
Since February 1996, French GPs are allowed to prescribe high dosage buprenorphine for maintenance treatment of major opioid drug addiction. A prospective cohort of major opioid addicts was initiated in order to assess patient outcomes: follow-up, retention rate in treatment, drug use, intravenous injection and social situation evolution.
Each GP, known to be involved in drug user management, had to include the first 10 opioid drug addict patients to whom he prescribed high dosage buprenorphine, with a maximum inclusion period of 3 months. Patients were followed up for two years and a regular standardized information was collected (usual data on drug users and prescription modalities).
Between May and July 1996, 919 patients (664 men and 255 women, mean age: 30 years) were included by 101 GPs. They had a long and serious history of drug addiction, important parallel consumption of cocaine, codeine and other illicit drugs and psychiatric problems (28% of definite problems and 45% of probable) and frequent hepatic conditions (hepatitis B: 23%, hepatitis C: 21%). Two years later, 55% of patients were still followed-up by the same GP and an additional 12% were followed by another GP or in a health care service (hospitalized or receiving methadone in a specialized centre). 13% were not followed, but GPs were able to describe their situation. 8% had been included by GPs who had dropped the study. Finally, 12% of patients were lost to follow-up. Among the 508 patients still followed-up by the same GP after 2 years, the substitution treatment rate was 84%. The dosage bracket had widened (inclusion: mean dosage=7.8 mg +/-4.5, minimum=0.8, maximum=28, median=8; after 2 years: mean=7.6 mg +/-5.4, minimum=0.4, maximum=28, median=8) and the duration of the prescription and dispensing had increased. Declaration of heroin intake in the previous month had fell from 40% to 11% and declaration of drug intake from 53% to 20%. Social situation had improved on average (housing conditions and work). There were 12 seroconversions for hepatitis B, 21 for hepatitis C and 4 for HIV. 14% of patients had declared intravenous injection of high dosage buprenorphine in the previous month.
After two years of follow-up, 55% of patients were still followed-up by the same GP and an additional 12% was followed by another GP or in a health care service. Among patients still followed up by the same GP, a reduction of drug related harm (seroconversions for hepatitis B, hepatitis C and HIV) was observed.
自1996年2月起，法国全科医生被允许开具高剂量丁丙诺啡用于主要阿片类药物成瘾的维持治疗。启动了一项针对主要阿片类成瘾者的前瞻性队列研究，以评估患者的治疗结果：随访情况、治疗保留率、药物使用情况、静脉注射情况及社会状况演变。
每位已知参与吸毒者管理的全科医生必须纳入其开具高剂量丁丙诺啡的前10名阿片类药物成瘾患者，最长纳入期为3个月。对患者进行了两年的随访，并收集了定期的标准化信息（吸毒者的常规数据和处方方式）。
1996年5月至7月期间，101名全科医生纳入了919名患者（664名男性和255名女性，平均年龄：30岁）。他们有长期且严重的药物成瘾史，同时大量吸食可卡因、可待因及其他非法药物，存在精神问题（明确问题占28%，可能问题占45%），且肝脏疾病频发（乙肝：23%，丙肝：21%）。两年后，55%的患者仍由同一名全科医生随访，另有12%的患者由另一名全科医生或在医疗服务机构（住院或在专门中心接受美沙酮治疗）随访。13%的患者未被随访，但全科医生能够描述其情况。8%的患者由退出研究的全科医生纳入。最后，12%的患者失访。在两年后仍由同一名全科医生随访的508名患者中，替代治疗率为84%。剂量范围变宽（纳入时：平均剂量=7.8毫克±4.5，最低=0.8，最高=28，中位数=8；两年后：平均=7.6毫克±5.4，最低=0.4，最高=28，中位数=8），处方和配药时长增加。前一个月海洛因摄入量的申报率从40%降至11%，药物摄入量的申报率从53%降至20%。社会状况平均有所改善（住房条件和工作）。乙肝血清学转换12例，丙肝21例，艾滋病毒4例。14%的患者申报前一个月曾静脉注射高剂量丁丙诺啡。
经过两年的随访，55%的患者仍由同一名全科医生随访，另有12%的患者由另一名全科医生或在医疗服务机构随访。在仍由同一名全科医生随访的患者中，观察到与药物相关的危害有所减少（乙肝、丙肝和艾滋病毒的血清学转换）。
