FRANÇAIS :
Un large sous-groupe des usagers d'héroïne, inséré socialement, qui ne désire pas entrer dans des programmes de maintenance à la méthadone ou en communauté thérapeutique, se trouve exclu du système de soins, malgré une volonté d'être pris en charge. 23 patients dans ce cas ont participé à un traitement à la buprénorphine en secteur privé et 40 ont suivi un protocole de sevrage. Les résultats montrent la faisabilité de tels traitements et amènent à reconsidérer la réglementation afin de réintroduire le traitement en pratique médicale privée.

ENGLISH:
At the conclusion of a 3-year demonstration project in a medical setting in which refusal to accept methadone was an inclusion criterion, 12 subjects were unable to detoxify from buprenorphine and remained adamant in their refusal to enroll in a MMTP. In order to study the feasibility of expanding opportunities for treatment previously unavailable to this under-served population of heroin addicts, these 12 subjects plus an additional 11 subjects (N = 23) were recruited for a 12 months trial of buprenorphine treatment conducted in an office-based setting on a fee-for-service basis. An additional cohort of 40 heroin dependent subjects were entered in a protocol for detoxification only. The findings demonstrate both feasibility and patient acceptance of office based fee-for-service buprenorphine treatment, supporting the need for (1) additional studies of this population and (2) changes in government regulations to reintroduce addiction treatment under physician auspices in private practice settings. (Author' s abstract)