Article de Périodique
Comparing methadone policy and practice in France and the US: Implications for US policy reform (2024)
Auteur(s) :
ENGLANDER, H. ;
CHAPPUY, M. ;
KRAWCZYCK, N. ;
BRATBERG, J. ;
POTEE, R. ;
JAUFFRET-ROUSTIDE, M. ;
ROLLAND, B.
Année :
2024
Page(s) :
art. 104487
Langue(s) :
Anglais
Domaine :
Drogues illicites / Illicit drugs
Thésaurus géographique
FRANCE
;
ETATS-UNIS
Thésaurus mots-clés
COMPARAISON
;
METHADONE
;
TRAITEMENT DE MAINTENANCE
;
POLITIQUE
;
PHARMACIE
;
OPIOIDES
;
ACCES AUX SOINS
;
CSAPA
;
POSOLOGIE
;
TRAITEMENT
Résumé :
Despite being among the most effective treatments for opioid use disorder, methadone is largely unavailable in the United States, due primarily to federal and other policies that limit its availability and regulate clinical decisions about doses, visit frequency, and drug testing. There is unprecedented momentum to change decades-old US methadone policies. Yet uncertainty remains as to whether reforms will be adopted and how policies will be implemented. France has among the best methadone access and lowest overdose death rates worldwide. 87% of French people with opioid use disorder receive methadone or buprenorphine, versus an estimated 13-20% in the US. France's opioid-related overdose rates are far lower than the US. This article compares French and US systems, including current and proposed US policies, and underscores potential implications for US policymakers.
In France, methadone can be initiated in specialty addiction settings and hospitals, with subsequent handoff to primary care. Methadone can be dispensed in community pharmacies and filled like other opioids, without requirements for supervised dosing. Decisions about visit frequency, medication doses, and drug testing are governed by clinical best practices and patient-clinician shared decision-making. In the US, methadone for opioid use disorder is regulated unlike any other medication (including methadone for pain) and is governed by strict federal controls, including from law enforcement and healthcare. With few exceptions, methadone for opioid use disorder is only available in Opioid Treatment Programs. US clinicians cannot prescribe methadone for opioid use disorder. Federal rules determine minimum visit frequency, initial dose limits, and other conditions of treatment, which states may further limit.
Policies assert strong influence on patient experience, treatment access, and health outcomes. Despite being less restrictive than the US, the French model includes limits designed to avoid or minimize potential harms. French policies have important implications for potential US reforms. [Author's abstract]
In France, methadone can be initiated in specialty addiction settings and hospitals, with subsequent handoff to primary care. Methadone can be dispensed in community pharmacies and filled like other opioids, without requirements for supervised dosing. Decisions about visit frequency, medication doses, and drug testing are governed by clinical best practices and patient-clinician shared decision-making. In the US, methadone for opioid use disorder is regulated unlike any other medication (including methadone for pain) and is governed by strict federal controls, including from law enforcement and healthcare. With few exceptions, methadone for opioid use disorder is only available in Opioid Treatment Programs. US clinicians cannot prescribe methadone for opioid use disorder. Federal rules determine minimum visit frequency, initial dose limits, and other conditions of treatment, which states may further limit.
Policies assert strong influence on patient experience, treatment access, and health outcomes. Despite being less restrictive than the US, the French model includes limits designed to avoid or minimize potential harms. French policies have important implications for potential US reforms. [Author's abstract]
Affiliation :
Section of Addiction Medicine in General Internal Medicine and the Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
Service Universitaire d'Addictologie de Lyon, Centre Hospitalier Le Vinatier, Bron, France
Centre de Soins d'Accompagnement et de Prévention en Addictologie, Hospices Civils de Lyon, Lyon, France
Service Pharmaceutique, Hospices Civils de Lyon, Lyon, France
Center for Opioid Epidemiology and Policy, NYU Grossman School of Medicine, New York NY, USA
University of Rhode Island College of Pharmacy, Kingston, RI, USA
Behavioral Health Network, Springfield, MA, USA
Centre d'étude des Mouvements Sociaux (Inserm U1276/CNRS UMR8044/EHESS), Paris, France
British Columbia Center on Substance Use (BCCSU), Vancouver, Canada
Baldy Center on Law and Social Policy, Buffalo University, New York City, NY, USA
Service Universitaire d'Addictologie de Lyon, Centre Hospitalier Le Vinatier, Bron, France
Centre de Soins d'Accompagnement et de Prévention en Addictologie, Hospices Civils de Lyon, Lyon, France
Service Pharmaceutique, Hospices Civils de Lyon, Lyon, France
Center for Opioid Epidemiology and Policy, NYU Grossman School of Medicine, New York NY, USA
University of Rhode Island College of Pharmacy, Kingston, RI, USA
Behavioral Health Network, Springfield, MA, USA
Centre d'étude des Mouvements Sociaux (Inserm U1276/CNRS UMR8044/EHESS), Paris, France
British Columbia Center on Substance Use (BCCSU), Vancouver, Canada
Baldy Center on Law and Social Policy, Buffalo University, New York City, NY, USA
Cote :
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