Comparison of high-dose buprenorphine treatments of opiate-dependent outpatients in four healthcare networks (2000)

FRANÇAIS :
Une étude rétrospective a été réalisée par 71 médecins généralistes, tirés au sort. Chaque investigateur pouvait inclure 5 patients dont le traitement par BHD avait été initié entre février 1996 et le 31 octobre 1996 (non perdus de vue au cours du 1er mois). Les taux de rétention totaux ont été élevés dans les 4 réseaux. Des effets positifs sur la réduction des risques et la diminution de la vulnérabilité sociale ont été observés. La prescription de BHD à une posologie quotidienne inférieure à 6,2 mg était associée à un pourcentage plus élevé de BZD. Par ailleurs, la prescription de BHD en plusieurs prises quotidiennes était associée à un pourcentage plus élevé d'injecteurs. (Résumé d'auteur.)
ENGLISH :
Aims. The aim of this study was to compare the various clinical practices in four health care networks and to access how the variations in treatment effected the outcome in opiate-dependent patients. Methods. A retrospective study was carried out with 71 participating general practitioners. These were chosen from a group of 354 practitioners from four health care networks. Each practitioner could enroll up to 5 patients who were currently undergoing treatment with high-dose buprenorphine (HDB). The patients treatment had to have been initiated between the first of February 1996 and the 31st of October 1996, and excluded any patients who hail lapsed on their treatment during the first month. Patients were selected until a total of 75 cases were carolled from each network. Data were then collected retrospectively between June and December 1997. Information collected concerned the initial stage of treatment, the stabilizing stage or level of treatment and followed up data on the most recent prescriptions. Results. The final patient maintenance totals were high for all four care networks (82.7 to 96% of patients were still being followed by their doctor at the final evaluation). A positive outcome as indicated by reduction of risk and decreased social vulnerability, was also observed in all networks. Additionally, in each network there was a clear correlation between prescription practices and patient behavior. For example, the prescription of HDB at a daily dose of less than 6.2 mg was associated with a higher rate of benzodiazepine use; and prescription of several daily doses of HDB was associated with a higher percentage of injecting patients. Conclusion. This retrospective study provides evidence that general practitioner care of drug-dependent patients as outpatients, within a health care network helps to stabilize patient visits, allows treatment of associated comorbidities and favors social rehabilitation. The prescription of HDB as a single daily dose, individually adapted for each patient, optimizes the outcome and reduces misuse. (Author's abstract.)