Skip to main content

Advertisement

SpringerLink
Log in

Why buprenorphine is so successful in treating opiate addiction in France

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Farrell M, Howes S, Verster A, et al., eds.: Reviewing Current Practice in Drug Substitution Treatment in the European Union. Luxembourg: Office for Official Publications of the European Communities; 2000.

    Google Scholar 

  2. EMCDDA: Annual Report on the State of the Drug Problem in the European Union and Norway. Luxembourg: Office for Official Publications of the European Communities; 2002.

    Google Scholar 

  3. Haasen C, Stallwitz A, Lachmann A, et al.: Management of High Risk Opiate Addicts in Europe (Risk Opiate Addicts Study — Europe) — Final Report. Hamburg, Germany: Centre for Interdisciplinary Addiction Research, University of Hamburg; 2004.

    Google Scholar 

  4. EMCDDA: Annual Report 2000: The State of the Drug Problem in the European Union and Norway. Lisbon: EMCDDA; 2000.

    Google Scholar 

  5. EMCDDA: Annual Report 2005: The State of the Drug Problem in the European Union and Norway, issue 3: Buprenorphine-Treatment, Misuse and Prescription Practices. Lisbon: EMCDDA; 2005.

    Google Scholar 

  6. Auriacombe M, Grabot D, Daulouède JP, et al.: Alternatives to methadone maintenance: laudanum, buprenorphine. In 54th Annual Scientific Meeting, College on Problems of Drug Dependence. Edited by Harris H. Keystone, CO: NIDA Research Monograph; 1992:308.

    Google Scholar 

  7. Auriacombe M, Grabot D, Daulouede JP, et al.: A naturalistic follow-up study of French-speaking opiate-maintained heroin-addicted patients: effect on biopsychosocial status. J Subst Abuse Treat 1994, 11:565–568.

    Article  PubMed  CAS  Google Scholar 

  8. Auriacombe M, Fatseas M, Dubernet J, et al.: French field experience with buprenorphine. Am J Addict 2004, 13(Suppl 1):S17–S28.

    Article  PubMed  Google Scholar 

  9. Auriacombe M: Overview on substitution treatment for heroin users in France. In Reviewing Current Practice in Drug Substitution Treatment in the European Union. Edited by Farrell M, Howes S, Verster A, et al.: Luxembourg: Office for Official Publications of the European Communities; 2000:119–134.

    Google Scholar 

  10. Obser vatoire Français des Drogues et des Toxicomanies: Les Traitements de Substitution en France: Résultats Récents 2004. Paris: Tendances; 2004:8.

    Google Scholar 

  11. Cadet-Taïrou A, Chollet D: La Substitution à Travers 13 Sites Français, 1999–2002. Pratiques et Disparités Régionales. Paris: CNAMTS/OFDT; 2004.

    Google Scholar 

  12. Feroni I, Paraponaris A, Aubisson S, et al.: Prescription de buprenorphine haut dosage par des médecins generalists. Rev Epidemiol Sante Publique 2004, 52:511–522.

    PubMed  CAS  Google Scholar 

  13. Strain EC, Stitzer ML, Liebson IA, Bigelow GE: Comparison of buprenorphine and methadone in the treatment of opioid dependence. Am J Psychiatry 1994, 151:1025–1030.

    PubMed  CAS  Google Scholar 

  14. Mattick RP, Kimber J, Breen C, Davoli M: Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2003, 2:CD002207.

  15. Cowan A, Lewis JW. Buprenorphine. New York: Wiley-Liss; 1995.

    Google Scholar 

  16. Fielding JE, Lancry PJ. Lessons from France—’vive la difference.’ The French health care system and US health system reform. JAMA 1993, 270:748–756.

    Article  PubMed  CAS  Google Scholar 

  17. Kopp P, Rumeau-Pichon C, Le Pen C: Les enjeux financiers des traitements de substitution dans l’heroinomanie: le cas de Subutex. Rev Epidemiol Sante Publique 2000, 48:256–270.

    PubMed  CAS  Google Scholar 

  18. Fédération Française d’addictologie: Stratégies thérapeutiques pour les personnes dépendantes des opiacés: place des traitements de substitution. Conférence de Consensus, 2004. Lyon, France; June 23–24, 2004.

  19. Bilal S, Menares J, De La Selle P, et al.: Impact des traitements de substitution aux opiacés sur la vie sociale. Une etude en medecine de ville. Ann Med Interne (Paris) 2003, 154(Suppl 2):S6–S14.

    Google Scholar 

  20. Duburcq A, Charpak Y, Blin P, Madec L: Suivi a 2 ans d’une cohorte de patients sous buprenorphine haut dosage. Resultats de l’etude SPESUB (suivi pharmaco-epidemiologique du Subutex en medecine de ville). Rev Epidemiol Sante Publique 2000, 48:363–373.

    PubMed  CAS  Google Scholar 

  21. Auriacombe M, Poutet R, Lavis E, et al.: Change in i.v. sharing behavior and condom use among admissions to opiate dependence treatment over a 10-year period (1994–2003). The College on Problems of Drug Dependence 67th Annual Scientific Meeting, 2005. Orlando, FL; June 19–23, 2005.

  22. De Ducla M, Gagnon A, Mucchielli A, et al.: Comparison of high dose buprenorphine treatments of opiate dependent outpatients in four healthcare networks. Ann Med Interne (Paris) 2000, 151(Suppl B):B9–B15.

    Google Scholar 

  23. De Ducla M, Gagnon A, Mucchielli A, et al.: Suivi de patients pharmacodependants aux opiaces traites par buprenorphine haut dosage a partir de reseaux de soins. Etude retrospective nationale. Experience de medecins generalistes francais. Ann Med Interne (Paris) 2000, 151(Suppl A):A27–A32.

    Google Scholar 

  24. Fhima A, Henrion R, Lowenstein W, Charpak Y: Suivi a 2 ans d’une cohorte de patients dependants aux opiaces traites par buprenorphine haut dosage (Subutex). Ann Med Interne (Paris) 2001, 152(Suppl 3):IS26–IS36.

    Google Scholar 

  25. Office Central Pour la Répression du Trafic Illicite des Stupéfiants: Usage et Trafic de Drogues en France. Les Statistiques de l’année 1998. Paris: Ministère de l’Intérieur; 1999.

    Google Scholar 

  26. Auriacombe M, Franques P, Tignol J: Deaths attributable to methadone vs buprenorphine in France. JAMA 2001, 285:45.

    Article  PubMed  CAS  Google Scholar 

  27. Lepere B, Gourarier L, Sanchez M, et al.: Diminution du nombre de surdoses mortelles a l’heroine, en France, depuis 1994. A propos du role des traitements de substitution. Ann Med Interne (Paris) 2001, 152(Suppl 3):IS5–IS12.

    Google Scholar 

  28. Emmanuelli J, Desenclos JC: Harm reduction interventions, behaviours and associated health outcomes in France, 1996–2003. Addiction 2005, 100:1690–1700.

    Article  PubMed  Google Scholar 

  29. Soyka M, Apelt SM, Lieb M, Wittchen HU: One-year mortality rates of patients receiving methadone and buprenorphine maintenance therapy: a nationally representative cohort study in 2694 patients. J Clin Psychopharmacol 2006, 26:657–660.

    Article  PubMed  CAS  Google Scholar 

  30. Soyka M, Penning R, Wittchen U: Fatal poisoning in methadone and buprenorphine treated patients — are there differences? Pharmacopsychiatry 2006, 39:85–87.

    Article  PubMed  CAS  Google Scholar 

  31. Kintz P: Deaths involving buprenorphine: a compendium of French cases. Forensic Sci Int 2001, 121:65–69.

    Article  PubMed  CAS  Google Scholar 

  32. Reynaud M, Petit G, Potard D, Courty P: Six deaths linked to concomitant use of buprenorphine and benzodiazepines. Addiction 1998, 93:1385–1392.

    Article  PubMed  CAS  Google Scholar 

  33. Reynaud M, Tracqui A, Petit G, et al.: Six deaths linked to misuse of buprenorphine-benzodiazepine combinations [letter]. Am J Psychiatry 1998, 155:448–449.

    PubMed  CAS  Google Scholar 

  34. Tracqui A, Kintz P, Ludes B: In buprenorphine-related deaths among drug addicts in France: a report on 20 fatalities. J Anal Toxicol 1998, 22:430–434.

    PubMed  CAS  Google Scholar 

  35. Tracqui A, Reynaud M, Petit G, et al.: Danger de l’utilisation détournée d’une association Benzodiazepines-buprenorphine. Sysnapse 1997, 133:41–46.

    Google Scholar 

  36. Observatoire Français des Drogues et des Toxicomanies: Rapport National Pour l’EMCDDA. Nouveaux Développements et Tendances, Conséquences Sanitaires. Paris: OFDT; 2005.

    Google Scholar 

  37. Damon M, Claroux-Bellocq D, Degré A: Substitution par la buprénorphine en médecine de ville, en Aquitaine. Revue Médicale de l’assurance Maladie 2001, 32:311–318.

    Google Scholar 

  38. Thirion X, Lapierre V, Micallef J, et al.: Buprenorphine prescription by general practitioners in a French region. Drug Alcohol Depend 2002, 65:197–204.

    Article  PubMed  CAS  Google Scholar 

  39. Vignau J, Duhamel A, Catteau J, et al.: Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients? J Subst Abuse Treat 2001, 21:135–144.

    Article  PubMed  CAS  Google Scholar 

  40. Feroni I, Peretti-Watel P, Paraponaris A, et al.: French general practitioners’ attitudes and prescription patterns toward buprenorphine maintenance treatment: does doctor shopping reflect buprenorphine misuse? J Addict Dis 2005, 24:7–22.

    Article  PubMed  Google Scholar 

  41. Carrieri MP, Amass L, Lucas GM, et al.: Buprenorphine use: the international experience. Clin Infect Dis 2006, 43(Suppl 4):S197–S215.

    Article  PubMed  CAS  Google Scholar 

  42. Blanchon T, Boissonnas A, Vareseon I, Vidal-Trecan G: Homelessness and high-dosage buprenorphine misuse. Subst Use Misuse 2003, 38:429–442.

    Article  PubMed  CAS  Google Scholar 

  43. Vidal-Trecan G, Varescon I, Nabet N, Boissonnas A: Intravenous use of prescribed sublingual buprenorphine tablets by drug users receiving maintenance therapy in France. Drug Alcohol Depend 2003, 69:175–181.

    Article  PubMed  Google Scholar 

  44. Thirion X, Micallef J, Barrau K, et al.: Observation of psychoactive substance consumption: methods and results of the French OPPIDUM programme. Eur Addict Res 2001, 7:32–36.

    Article  PubMed  CAS  Google Scholar 

  45. Thirion X, Micallef J, Guet F, et al.: Dependance aux psychotropes et traitements de substitution: tendances recentes a propos de l’enquete OPPIDUM des Centres d’Evaluation et d’Information sur les Pharmacodependances (CEIP) d’octobre 1997. Therapie 1999, 54:243–249.

    PubMed  CAS  Google Scholar 

  46. Moatti JP, Vlahov D, Feroni I, et al.: Multiple access to sterile syringes for injection drug users: vending machines, needle exchange programs and legal pharmacy sales in Marseille, France. Eur Addict Res 2001, 7:40–45.

    Article  PubMed  CAS  Google Scholar 

  47. Obadia Y, Perrin V, Feroni I, et al.: Injecting misuse of buprenorphine among French drug users. Addiction 2001, 96:267–272.

    Article  PubMed  CAS  Google Scholar 

  48. Valenciano M, Emmanuelli J, Lert F: Unsafe injecting practices among attendees of syringe exchange programmes in France. Addiction 2001, 96:597–606.

    Article  PubMed  CAS  Google Scholar 

  49. Fontaa V, Bronner C: Persistance de la pratique d’injection chez des patients substitues par methadone ou buprenorphine haut dosage. Ann Med Interne (Paris) 2001, 152(Suppl 7):59–69.

    Google Scholar 

  50. Franques P, Lavie E, Encrenaz G, et al.: Facteurs d’évolution du comportement de dépendance sous traitement par buprénorphine: mésusage de la buprénorphine par voie veineuse en situation de traitement. Importance du phénomène et caractéristiques des sujets. Résultats préliminaires à partir d’une étude en cours. Courrier des Addictions 2003, 5:14–18.

    Google Scholar 

  51. Escot S, Fahet G: Usages non Substitutifs de la Buprénorphine Haut Dosage Menée en France, en 2002–2003. Paris: OFDT; 2004.

    Google Scholar 

  52. Auriacombe M, Franques P, Daulouède J, et al.: Traitements de substitution: le médicament est. celui qui le donne. Les modalités de mise à disposition d’un traitement de substitution par buprénorphine influencent-elles la réponse générale au traitement? Courrier des Addictions 2002, 4:104–106.

    Google Scholar 

  53. ANAES: Evaluation des Réseaux de Soins: Bilan de l’existant et Cadre Méthodologique. Paris: ANAES; 2001.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Département d’Addictologie, Centre Carreire, 121, rue de la Béchade, 33076, Bordeaux Cedex, France

    Marc Auriacombe

Authors
  1. M. Fatseas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc Auriacombe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc Auriacombe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fatseas, M., Auriacombe, M. Why buprenorphine is so successful in treating opiate addiction in France. Curr Psychiatry Rep 9, 358–364 (2007). https://doi.org/10.1007/s11920-007-0046-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-007-0046-2

Keywords

Search

Navigation