Périodique
Effective medical treatment of opiate addiction
(Un traitement médical efficace de l'addiction aux opiacés)
Auteur(s) :
National Institutes of Health (NIH)
Année :
1998
Page(s) :
1936-1943
Langue(s) :
Anglais
Refs biblio. :
64
Domaine :
Drogues illicites / Illicit drugs
Thésaurus mots-clés
OPIACES
;
DEPENDANCE
;
TRAITEMENT
;
MEDECIN
;
METHADONE
;
ACCES AUX SOINS
;
TRAITEMENT DE MAINTENANCE
;
FORMATION
;
REGLEMENTATION
;
PROTECTION SOCIALE
Thésaurus géographique
ETATS-UNIS
Note générale :
Journal of the American Medical Association, 1998, 280, (22), 1936-1943
Résumé :
FRANÇAIS :
Les conférences de consensus de l'Institut National de la Santé (USA), ont comme objectif d'évaluer les connaissances scientifiques existantes et de résoudre les questions de sécurité et d'efficacité liées à la technologie biomédicale. Cet article résume la conférence concernant la prise en charge médicale des addictions aux opiacés. Sont décrites : la composition du panel scientifique, la littérature étudiée, la méthodologie mise en oeuvre et les conclusions de la conférence. La conférence recommande de considérer la dépendance aux opiacés comme un trouble médical de type cérébral qui peut être traité de façon efficace pour le patient et la société. Il est de l'intéret pour la société de s'engager à offrir une prise en charge efficace de la dépendance aux opiacés à toute personne qui en éprouve le besoin. Toutes les personnes dépendantes aux opiacés devraient avoir accès aux traitements de maintenance à la méthadone sous couverture légale et les services judiciaires et instances de contrôle américaines devraient faire les démarches nécessaires pour appliquer cette recommandation. Il est nécessaire d'adapter la formation des médecins et des autres professionnels de la santé. La conférence plaide également pour un assouplissement des règles d'indication des traitements de maintenance à la méthadone et d'autres programmes de traitement à long terme impliquant la prescription d'agonistes et d'en améliorer la couverture sociale.
ENGLISH :
Objective : To provide clinicians, patients, and the general public with a responsible assessment of the effective approaches to treat opiate dependence. Participants : A nonfederal, nonadvocate, 12-member panel representing the fields of psychology, psychiatry, behavioral medicine, family medicine, drug abuse, epidemiology, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 600. Presentations and discussions were divided into 3 phases over 2 1/2 days: (1) presentations by investigators working In the areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of a third day. The conference was organized and supported by the Office of Medical Applications of Research, National Institutes of Health. Consensus Process : The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its enti- rety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finialized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions. Conclusions : Opiate dependence is a brain-related medical disorder that can be effectively treated with significant benefits for the patient and society, and society must make a commitment to offer effective treatment for opiate dependence to all who need it. All persons dependent on opiates should have access to metha- done hydrochloride maintenance therapy under legal supervision, and the US Of fice of National Drug Control Policy and the US Department of Justice should take the necessary steps to implement this recommendation. There is a need for improved training for physicians and other health care professionals. Training to determine diagnosis and treatment of opiate dependence should also be improved in medical schools. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance program. (Extract of the publication.)
Les conférences de consensus de l'Institut National de la Santé (USA), ont comme objectif d'évaluer les connaissances scientifiques existantes et de résoudre les questions de sécurité et d'efficacité liées à la technologie biomédicale. Cet article résume la conférence concernant la prise en charge médicale des addictions aux opiacés. Sont décrites : la composition du panel scientifique, la littérature étudiée, la méthodologie mise en oeuvre et les conclusions de la conférence. La conférence recommande de considérer la dépendance aux opiacés comme un trouble médical de type cérébral qui peut être traité de façon efficace pour le patient et la société. Il est de l'intéret pour la société de s'engager à offrir une prise en charge efficace de la dépendance aux opiacés à toute personne qui en éprouve le besoin. Toutes les personnes dépendantes aux opiacés devraient avoir accès aux traitements de maintenance à la méthadone sous couverture légale et les services judiciaires et instances de contrôle américaines devraient faire les démarches nécessaires pour appliquer cette recommandation. Il est nécessaire d'adapter la formation des médecins et des autres professionnels de la santé. La conférence plaide également pour un assouplissement des règles d'indication des traitements de maintenance à la méthadone et d'autres programmes de traitement à long terme impliquant la prescription d'agonistes et d'en améliorer la couverture sociale.
ENGLISH :
Objective : To provide clinicians, patients, and the general public with a responsible assessment of the effective approaches to treat opiate dependence. Participants : A nonfederal, nonadvocate, 12-member panel representing the fields of psychology, psychiatry, behavioral medicine, family medicine, drug abuse, epidemiology, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 600. Presentations and discussions were divided into 3 phases over 2 1/2 days: (1) presentations by investigators working In the areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that are part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of a third day. The conference was organized and supported by the Office of Medical Applications of Research, National Institutes of Health. Consensus Process : The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its enti- rety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finialized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions. Conclusions : Opiate dependence is a brain-related medical disorder that can be effectively treated with significant benefits for the patient and society, and society must make a commitment to offer effective treatment for opiate dependence to all who need it. All persons dependent on opiates should have access to metha- done hydrochloride maintenance therapy under legal supervision, and the US Of fice of National Drug Control Policy and the US Department of Justice should take the necessary steps to implement this recommendation. There is a need for improved training for physicians and other health care professionals. Training to determine diagnosis and treatment of opiate dependence should also be improved in medical schools. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance program. (Extract of the publication.)
Affiliation :
Natl. Inst. Hlth. Consensus Program Info Ctr., POB 2577, Kensington, MD 20891
Etats-Unis. United States.
Etats-Unis. United States.