Phan Olivier, Sanchez Mario, Bouthillon-Heitzmann Pascale
Institut mutualiste Montsouris, service de psychiatrie, Paris (75).
Presse Med. 2005 Jun 4;34(10):711-8. doi: 10.1016/s0755-4982(05)84024-2.
In France today, the treatment of opiate and notably heroin addiction with high-dose buprenorphine (HDB) is widespread. Although this treatment has been successful to some extent, problems persist. One is that some percentage (estimated at 17-47%) of patients "misuses" their HDB, either by intravenous injection or inhalation. This misuse presents a public health problem, since injecting drug users are more frequently infected by hepatitis C, and may even jeopardize the treatment's efficacy.
Our study compared a sample of 26 patients treated with sublingual HDB who reported injecting it on occasion and 27 patients under HDB who did not inject it.
There was no evidence of more psychiatric disorders in the population that injected HDB than in the population that did not. Conversely, the patients injecting HDB used more illicit products, more benzodiazepines and more alcohol.
Despite its efficacy, substitution treatment does not appear to provide relief for some patients. HDB injection may thus correspond to a search for a precarious balance: the disruption of the HDB kinetics induced by its injection would be aimed at enhancing the opiate effect. The consumption of other licit and illicit psychotropic agents indicates a further attempt to obtain relief from a persistent mental discomfort, over and above the substitution therapy and even its misuse. The reality of the psychological imbalance experienced with, induced by or pre-existing the heroin use requires rethinking the overall treatment. Future studies should lead to the identification of the disorders that lead these patients to seek relief in injections.
在当今法国，使用高剂量丁丙诺啡（HDB）治疗阿片类药物成瘾，尤其是海洛因成瘾的情况很普遍。尽管这种治疗在一定程度上取得了成功，但问题依然存在。其中一个问题是，有一定比例（估计为17%-47%）的患者通过静脉注射或吸入“滥用”他们的HDB。这种滥用带来了公共卫生问题，因为注射吸毒者感染丙型肝炎的频率更高，甚至可能危及治疗效果。
我们的研究比较了26例偶尔报告注射舌下HDB的患者样本和27例未注射HDB的患者样本。
没有证据表明注射HDB的人群比未注射的人群有更多精神障碍。相反，注射HDB的患者使用更多非法产品、更多苯二氮䓬类药物和更多酒精。
尽管替代治疗有效，但似乎并不能让一些患者得到缓解。因此，注射HDB可能是为了寻求一种不稳定的平衡：其注射引起的HDB动力学破坏旨在增强阿片类药物的效果。使用其他合法和非法精神药物表明，除了替代疗法甚至其滥用之外，患者还进一步试图缓解持续的精神不适。海洛因使用所经历的、由其引起的或预先存在的心理失衡的现实情况需要重新思考整体治疗方法。未来的研究应能确定导致这些患者通过注射寻求缓解的病症。
