Evaluation survey of a methadone treatment share care programme between a specialized clinic and a network of GPs

FRANÇAIS :
Cette enquête relate l'expérience française menée par l'Espace Tolbiac, clinique spécialisée qui accueille des toxicomanes dans le cadre de traitements de maintenance à la méthadone. Une fois les patients stabilisés (ne consommant plus de drogues illicites, ayant une situation sociale stable, etc.), ils sont adressés à des médecins généralistes et poursuivent leur traitement en médecine de ville. La présente enquête étudie le devenir de 296 patients ayant bénéficié de ce protocole.
ENGLISH :
Emergence Espace-Tolbiac is a methadone treatment clinic. Over the last 5 years, EET has initiated methadone treatment with 738 patients, including 548 who have been referred to a network of 220 GPs. The way of service functions is defined by the French regulations for methadone treatment. Such treatment must be initiated by specialized clinics, but once patients have stabilized, can be referred to GPs. Our service initiates the treatment, and patients stay at the clinic, where methadone is administered every day by a specialized team. During the first few weeks, the patient's needs are evaluated and he or she is referred to various professionals, such as social workers, doctors and psychiatrists, according to whatever is appropriate in each case. Patients are referred to GPs when the evaluation is made that they no longer abuse drugs such as heroin or cocaine, or other substances such as alcohol or benzodiazepine. They must have social resources and available accommodation. Patients suffering from a psychiatric disorder do not receive referrals until their condition has been stabilized by any kind of treatment. So far 40% of our patients have received a referral after an average of 2 months at the clinic, and 30% after an average of 9 months, while 18% have stayed at the clinic for over 2 years. A follow-up has been conducted on 296 patients referred to GPs (32 GPs failed to answer) After an average of a year and a half on treatment, 5% were no longer available for follow-up, and 85% are still being advised by their GP. Of these, 95% are still being treated with methadone. Most of the others (9/13), are being treated with high-dosage buprenorphine (Subutex). The mean dosage is 60mg/day, 15 mg less than at the end of the stay at the centre. Relationships with other professionals are frequent (67% of patients). 20% are still in contact with the centre. (Editor' s abstract)