Fatseas M, Auriacombe Marc
Département d'Addictologie, Centre Carreire, 121 rue de la Béchade, 33076 Bordeaux Cedex, France.
Curr Psychiatry Rep. 2007 Oct;9(5):358-64. doi: 10.1007/s11920-007-0046-2.
In France, all registered medical doctors have been allowed to prescribe buprenorphine without any special education or licensing since 1995. This has led to a rapidly increasing number of opiate-dependent users under buprenorphine treatment in primary care. French physician compensation mechanisms, pharmacy services, and medical insurance funding all have contributed to minimizing barriers to buprenorphine treatment. Approximately 20% of all physicians in France are prescribing buprenorphine to treat more than one half of the estimated 180,000 problem heroin users. Intravenous diversion of buprenorphine may occur in up to 20% of buprenorphine patients and has led to relatively rare overdoses in combination with sedatives, whereas total opiate overdose deaths have declined substantially. In France, buprenorphine maintenance treatment for problem opiate users was feasible and safe through office-based prescriptions in a relaxed regulatory environment.
自1995年起，法国所有注册医生无需接受任何特殊教育或获得许可即可开具丁丙诺啡。这使得在初级保健中接受丁丙诺啡治疗的阿片类药物依赖使用者数量迅速增加。法国医生的薪酬机制、药房服务和医疗保险资金都有助于最大限度地减少丁丙诺啡治疗的障碍。法国约20%的医生开具丁丙诺啡用于治疗估计18万问题海洛因使用者中的一半以上。高达20%的丁丙诺啡患者可能会出现丁丙诺啡的静脉转移，并导致与镇静剂联合使用时相对罕见的过量用药情况，而阿片类药物过量死亡总数已大幅下降。在法国，在宽松的监管环境下，通过门诊处方对问题阿片类药物使用者进行丁丙诺啡维持治疗是可行且安全的。
