Injecting misuse of buprenorphine among French drug users (2001)

FRANÇAIS :
Etude tranversale menée en septembre 1997 auprès d'usagers fréquentant 32 pharmacies, 4 programmes d'échange de seringues et 3 distributeurs de seringues dans la ville de Marseille. Parmi les 343 participants à l'enquête, 33,8 % étaient des polyconsommateurs s'injectant occasionnellement de la buprénorphine, parallélement à des injections d'héroïne ou de cocaïne, et 23,9% ne s'étaient injecter que de la buprénorphine durant les 6 mois précédents. Ces derniers étaient plus jeunes, pratiquaient des injections plus fréquemment et étaient le plus souvent en traitement de maintenance à la buprénorphine. Par ailleurs, ils étaient moins susceptibles d'être contaminés par le VIH et déclaraient moins de conduites à risque liées à l'injection.
ENGLISH :
Aims. To evaluate the extent to which the introduction (February 1996) of ambulatory prescriptions of buprenorphine for drug maintenance treatment (DMT) has been associated with its intravenous illicit use by French injecting drug users (IDUs). Design. Cross-sectional survey (September 1997), using self-administered questionnaires, in a sample of IDUs recruited at 32 pharmacies, four needle exchange programmes and three syringe vending machines. Setting. Thirty-nine sites where IDUs have access to sterile syringes in the city of Marseille (South-Eastern France). Participants. Sample of IDUs attending community pharmacies, vending machines and needle exchange programs to obtain equipment. Measurement. To compare characteristics of IDUs who declared that they only injected buprenorphine in the prior 6 months versus the rest of the sample. Findings. Among the 343 respondents (response rate = 70.7%), 33.8% were polydrug users who occasionnally injected buprenorphine in parallel to heroin and/or cocaine, while 23.9% only injected buprenorphine in the previous 6 months. IDUs in this latter group were younger, injected more frequently, and were more frequently on buprenorphine DMT, but they were less likely to be HIV-infected and to declare HIV-related injecting risky behaviours. Conclusions. Substantial risk of injecting misuse is associated with large-scale diffusion of buprenorphine DMT. A more stringent regulation for medical dispensation of buprenorphine than the current French general freedom of prescription for all physicians, including general practicioners in ambulatory care, may be necessary in other countries which are considering the diffusion of buprenorphine DMT. (Author' s abstract)