Courty Pascal
Unité Méthadone-CMP B, CHRU Gabriel-Montpied, rue Montalembert, 63003 Clermont-Ferrand Cedex 1.
Ann Med Interne (Paris). 2003 Jun;154 Spec No 1:S35-45.
In France, by the end of 1999, a study of a naturalistic-type was led by the Louis-Harris Institute on 303 persons taking high dosage (HD) buprenorphine. This study aimed to identify factors likely to be correlated with stopping or continuing HD buprenorphine injections. We carried out a comparative study of four groups of HD buprenorphine users: "non-injectors" (n=90), "ex-injectors" (n=71), "monitored injectors" (n=69) and "un-monitored injectors" (n=72), with intra-group representativeness. The data was gathered in the context of anonymous interviews, by objective interviewers, in 20 regions. Most of the interviewees were also users or ex-users of more than one psychoactive substance. The "un-monitored injector" group was younger than the "non-injector" group and not as well integrated into society. The injection frequency was lower in patients receiving medical care. Research into the reasons for stopping and cutting down on HD buprenorphine injections revealed indicators such as the impossibility of breaking the injection habit, the fact that users seek the immediate sedation effect, and associating with friends who also inject. These factors seem to be greatest during critical periods, such as depression or the absence of well being. We showed that the factors involved in cutting down included: revaluation of the way in which the medicine was taken with the doctor, and becoming aware of the problems resulting from injection through information received from the doctor and/or by experiencing problems firsthand. In all the groups, the benefits associated with taking HD buprenorphine were observed and evaluated, starting with a list of 14 items. Five main benefits were found: cutting down on or stopping heroine, taking better care of oneself, making new plans, being in better physical shape, and finally, sleeping better. The improvement was greatest in the "non-injector" and "ex-injector" groups. The work that would be necessary to establish effective medical support involves a global approach including an appropriate initial prescription, paying special attention during critical periods, and verification of the mode of use so as to avoid under-dosing, and constant evaluation of the risk of resorting to injections. The fact that there are ex-injectors and that some regular injectors have not resorted to injecting during the last month shows the benefits of medical support.
1999年底，法国路易 - 哈里斯研究所针对303名高剂量使用丁丙诺啡的人员开展了一项自然主义类型的研究。该研究旨在确定可能与停止或继续高剂量丁丙诺啡注射相关的因素。我们对四组高剂量丁丙诺啡使用者进行了对比研究：“非注射者”（n = 90）、“曾经的注射者”（n = 71）、“受监测的注射者”（n = 69）和“未受监测的注射者”（n = 72），组内具有代表性。数据是在20个地区由客观的访谈者在匿名访谈的背景下收集的。大多数受访者还是不止一种精神活性物质的使用者或曾经的使用者。“未受监测的注射者”组比“非注射者”组更年轻，且融入社会的程度较低。接受医疗护理的患者注射频率较低。对停止和减少高剂量丁丙诺啡注射原因的研究揭示了一些指标，比如难以戒除注射习惯、使用者追求即时镇静效果以及与同样注射的朋友交往。在诸如抑郁或感觉不适等关键时期，这些因素似乎最为突出。我们发现，减少注射的相关因素包括：与医生重新评估用药方式，以及通过从医生处获得的信息和/或亲身经历问题，意识到注射带来的问题。在所有组中，从一份包含14项内容的清单开始，观察并评估了与使用高剂量丁丙诺啡相关的益处。发现了五个主要益处：减少或停止使用海洛因、更好地照顾自己、制定新计划、身体状况更佳以及最后睡眠更好。“非注射者”和“曾经的注射者”组的改善最为明显。建立有效的医疗支持所需开展的工作涉及一种全面的方法，包括适当的初始处方、在关键时期给予特别关注、核实使用方式以避免剂量不足，以及持续评估注射风险。存在曾经的注射者以及一些定期注射者在过去一个月未进行注射这一事实表明了医疗支持的益处。
