Primary care of opioid use disorder: The end of "the French model"? (2020)

BACKGROUND: In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a 'French model' facilitating access to treatment based on the involvement of GPs in buprenorphine prescription.
OBJECTIVES: Our study aimed to assess whether the involvement of primary care in OUD management has changed lately.
MATERIALS AND METHODS: Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009-2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP.
RESULTS: Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (n = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 +/- 27.1 patients in 2009 to 16.0 +/- 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period.
CONCLUSIONS: Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.