"Horse trading" : prescribing injectable opiates to opiate addicts. A descriptive study

FRANÇAIS :
Même si cela paraît contradictoire, certains centres de traitement prescrivent des opiacés injectables aux toxicomanes, dans le but de les attirer vers les soins et de les amener à cesser leurs injections. Sur les 40 toxicomanes considérés dans cette étude anglaise, tous refusent au départ les opiacés par voie orale. Si on a réussi à fidéliser leur fréquentation du centre de soins (45 semaines), 35 d'entre eux ont toutefois continué leur pratique d'injection. 9 ont été admis pour sevrage résidentiel, 8 ont connu une dégradation de leur mode de vie et 14 des changements positifs. La discussion est ouverte sur le bénéfice de cette méthode et la prudence qu'elle nécessite.
ENGLISH :
40 opiate-dependent individuals were prescribed injectable drugs. These subjects were characterized by the chronicity of their injecting and dependent opiate use, and by their refusal to comply with a treatment programme involving oral-only prescribing. The key aim was to attract entrenched injectors into contact with treatment services and to promote movements away from injecting drug use and reduce HIV risk behaviour. On review 35 of the original 40 were either still receiving an injectable prescription or injecting illicit drugs. Despite this 14 (35 %) were rated as making positive life changes. 9 (22. 5 %) had been admitted to the in-patient unit and became drug free during their stay. The stability of the lives of eight (20 %) had deteriorated. The benefits and drawbacks of this form of intervention are discussed. (Extract from author's abstract)