Buprenorphine for office-based practice: consensus conference overview (2004)

FRANÇAIS :
Article d'introduction au supplément de la revue consacré aux recommandations de la conférence de consensus de mars 2003, aux Etats-Unis sur l'utilisation de la buprénorphine en médecine générale. Des experts répondent aux questions soulevées par les recommandations concernant l'accès au traitement, la formation des médecins, la pratique de prescription (posologie, évaluation du patient, contrôle de la prescription), les résultats et le rôle de l'accueil et des services annexes dans la prise en charge des patients dépendants des opiacés.
ENGLISH :
This overview of the March 2003 conference on the U.S national buprenorphine implementation program is developed to inform the practitioner about the positive experience that has been accumulated worldwide on the use of buprenorphine for office-based practice. The first paper delineates the challenges for American psychiatry in moving buprenorphine forward into general practice. Most psychiatrists are unprepared to work with opiate-dependent patients or to use buprenorphine. The international successes with office-based buprenorphine from France and Australia are presented in the next papers, followed by presentations on several U.S. studies using buprenorphine in the community for detoxification and office-based maintenance. These experiences have thus far confirmed buprenorphine's utility and promise for opiate addiction treatment in the U.S. Finally, two national monitoring programs have been implemented to assess the public health impact of this new treatment opportunity. This opportunity has a three-year window, however, and a critical need will be to attract a sufficient number of physicians into prescribing buprenorphine/naloxone in order to allow our patients increased access to this treatment.