|Titre :||Les traitements de substitution dans les toxicomanies aux opiacés. Congrès de psychiatrie et de neurologie de langue française. Tours 15-20 juin 1997|
|Titre original:||(Substitution treatment of opiates addicts. Meeting of psychiatry and neurology, Tours, 15-20 June, 1997)|
|Auteurs :||J. M. PINOIT ; I. FRANÇOIS|
|Type de document :||Livre|
|Editeur :||Paris : Masson, 1997|
|Format :||261 p. / graph. ; tabl.|
|Note générale :||
Paris, Masson, 1997, 261 p., graph., tabl.
|Discipline :||TRA (Traitement et prise en charge / Treatment and care)|
Thésaurus TOXIBASEOPIACES ; METHADONE ; BUPRENORPHINE ; PHARMACOLOGIE ; PHARMACOCINETIQUE ; TOXICOLOGIE ; DEPENDANCE ; TRAITEMENT ; SUBSTITUTION ; REDUCTION DES RISQUES ; PRESCRIPTION MEDICALE ; LEGISLATION
Thésaurus GéographiqueFRANCE ; ETATS-UNIS ; ROYAUME-UNI ; PAYS-BAS ; SUISSE
Les aspects législatifs et réglementaires de la toxicomanie sont rappelés et commentés, afin de situer la problématique de la substitution en France. Les principaux indicateurs épidémiologiques (produits consommés, âge, sexe, morbidité, mortalité) permettent de mentionner les tendances, d'évaluer le recours aux soins et les risques infectieux. A travers les expériences étrangères: anglo-saxonnes, suisses ou hollandaises de prescription de méthadone ou d'opiacés, on peut voir que la réduction des risques est toujours au premier plan, et que la mise en place des traitements de substitution est de nature politique, quelles que soient les avancées de la recherche médicale. La deuxième partie de ce rapport rappelle les caractéristiques pharmacologiques et cliniques des produits de substitution utilisés en France: méthadone et buprénorphine haut dosage, et aussi celle du LAAM, qui pourrait être utilisé dans l'avenir.
The objective of this work is to present the different elements which allow the prescription of substitution medications in France. A large part of this publication consists, of course, of the results of scientific research, but other approaches would also seem to be indispensable and are presented in the earlier chapters. Firstly, the French legal and regulatory aspects are presented. We then present a certain number of epidemiological landmarks, despite the difficulties involved in learning about a phenomenon both complex and illegal:
- Drug addiction is no longer limited uniquely to the larger cities.
- The population ageing trend continues with the passage of time.
- There is a significant rise in multidrug users.
- The stabilisation of heroin use after increasing throughout the 1980's.
- The considerable expansion of Ecstasy consumption is doubtless the most notable of these phenomena.
As for aid and social care for addicts, these continue to develop and diversify. The coming of substitution treatment is at the heart of this problem. Whilst easily accessible for drug users, substitution treatment results in an increase in medical treatment by General Practitioners. As for the state of health of drug users, HIV infects approximately 20% of addicts. And more recently, we have seen greater rates of infection by the Hepatitis C virus. The prevalence of tuberculosis in drug addicts is not exactly known at present. Mortality related to drug use concerns mostly young people, heroin being almost always the cause, sometimes taken in association with medications. A revue of foreign experience of drug substitution follows: The USA was the first country to implement a programme, and has perfected a number of protocols which have served as a foundation for drug substitution in France. Despite this, we note that the prescription of drugs is not related to scientific research results. Decisions taken in this field would seem to be governed by cultural criteria and political choices. The British experience is interesting for two reasons. Firstly, the prescription of drugs is an old practice and more widely spread than in France, as an analgesic as well as substitution. The thrust has always been towards health, contrary to the USA where drug problems have generally been tackled by an oppressive approach. Secondly, there is , in Britain, a rigorously controlled programme for the prescription of heroin (intravenous). The ins and outs of such an experiment are of course very important to know. Holland has been confronted on a massive scale by the problems of managing drug addiction, and it is hardly surprising that substitution treatments have been developed there much earlier than in France. An interesting experiment is based on the prescription of injectable morphine. Finally, the Swiss experience deserves some attention, notably because of the multi-centred research carried out up till December 1996 concerning different substitution treatments. To date, only preliminary results have been released, but this represents an important synthesis in terms of acquired knowledge in this field. The second part covers the three heroin substitution medications, methadone, buprenorphine, (both used in France) and levo-alpha-acetyl-methadol (which might soon be permitted). The methadone monograph is shown in a very precise manner, its effects, as a substitute and the pharmacological data are important. In a second chapter, the results of clinical trials in the USA are presented. An examination of various problems follows; patient admission, methadone dosage determination, urine analysis, the problems of take- home methadone, pregnancy related specifics, the problems of associated infectious illness, of multidrug use, and lastly the treatment duration. In a third chapter, the French experience is covered. Having reviewed the institutional framework, we examine the main results obtained, in particular, the experiences of the two oldest centres are studied in detail, we cover certain problems such as patient evaluation, treatment of associated depression, and the problems of associated psychiatric illness, and the aspects of decease of patients in the methadone programme. The specifics of levo-alpha-acetyl-methadol are outlined and we compare it to methadone. As for buprenorphine, its properties are studied in the same manner as for the methadone. Clinical trials carried out in the USA are examined, and a further chapter covers cocaine addiction treatment with buprenorphine. The situation in France is of course studied, leading to the necessity to evaluate patients and working in a healthcare network. (Editor' s abstract)
|Note de contenu :||graph. ; tabl.|
|Domaine :||Drogues illicites / Illicit drugs|
|Refs biblio. :||308|
|Affiliation :||Serv. Univ. Psychiatr. Adultes, CHU Dijon France. France.|
|Numéro Toxibase :||802468|
|Centre Emetteur :||13 OFDT|