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Archived Comments for: The management of opiate use disorders in France: results of an observational survey of general practitioners

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  1. Patients treated by buprenorphine versus methadone in France in general practice.

    Julie Dupouy, University of Toulouse, Department of Family Medicine

    3 February 2016

    Recent data estimates that near 170 000 patients are treated by an opiate maintenance treatment (OMT) in 2012 in France (1).

    Poloméni and colleagues (2) studied the management of opiate use disorders in France using a survey among general practitioners (GPs). GPs were selected randomly thanks to a national list belonging to the Cegedim group and were interviewed by phone.

    One of their results about OMT is that 59% of patients being prescribed an OMT by a GP received buprenorphine and 37% methadone. The authors suggested a shift from buprenorphine towards methadone.

    Nevertheless, in a cohort of 1507 patients newly treated by OMT in South of France between 2009 and 2011, we observed 1053 patients (69.9%) treated by buprenorphine only along their follow-up and 344 (22.8%) by methadone only (4). Moreover, reimbursement data showed that buprenorphine reimbursement increased between 2004 and 2010 (+29.6% of insures having been treated by this drug) (3).

    These reimbursement data are in accordance with other studies showing the widespread of buprenorphine in France where buprenorphine is easily obtainable (5). In France, methadone must be started in a specialized unit or a hospital and can be continued, after the patient is stabilized, in an outpatient setting, whereas buprenorphine can be started as well as in a specialized unit, than in a hospital or an outpatient setting. All general practitioners are allowed to prescribe buprenorphine in their medical office (a specific training is not required). Methadone can be prescribed for a maximum of 14 days and buprenorphine for 28 days. Thus, more than three-quarters of patients treated for opioid addiction receive buprenorphine (5,6) most of them being treated in general practice using this drug (5).

    Buprenorphine, thanks to its partial µ agonist characteristics, is considered as a safe treatment with a lower risk of deaths than methadone, particularly by overdose (7–9), even if its abuse has been found to be associated with a three times higher mortality rate in Finland (10). In France, buprenorphine abuse concerns a stable proportion - around 10% - of the OMT treated patients (11).

    In conclusion, in ambulatory care, in France, around 70% of patients being treated by an OMT received buprenorphine.

     

    Julie Dupouy, M.D., Ph.D.

    Stéphane Oustric, M.D.

    Maryse Lapeyre-Mestre, M.D., Ph.D.

     

     


     

    References:

    1.         OFDT: Les traitements de substitution aux opiacés : données récentes. Tendances 2014, 94. http://www.ofdt.fr/publications/collections/periodiques/lettre-tendances/les-traitements-de-substitution-aux-opiaces-donnees-recentes-tendances-94-octobre-2014/

    2.         Poloméni P, Bronner C, Fry F, Ravoninjatovo B, Fatseas M: The management of opiate use disorders in France: results of an observational survey of general practitioners. Addict Sci Clin Pract 2015, 10(1):16.

    3.         Commission nationale des stupefiants et psychotropes: Seance du 17/02/2011. http://www.ansm.sante.fr/var/ansm_site/storage/original/application/b2fb75f473939d0e4f5cdf8c2c46d59f.pdf

    4.         Dupouy J, Dassieu L, Bourrel R, Poutrain J-C, Bismuth S, Oustric S, et al: Effectiveness of drug tests in outpatients starting opioid substitution therapy. J Subst Abuse Treat 2013, 44: 515–521.

    5.       Fatseas M, Auriacombe M. Why buprenorphine is so successful in treating opiate addiction in France. Curr Psychiatry Rep 2007, 9(5):358‑64.

    6.       Auriacombe M, Fatséas M, Dubernet J, Daulouède J-P, Tignol J: French field experience with buprenorphine. Am J Addict 2004; 13 Suppl 1:S17‑28.

    7.       Auriacombe M, Franques P, Tignol J: Deaths attributable to methadone vs buprenorphine in France. JAMA 2001, 285(1):45.

    8.       Bell JR, Butler B, Lawrance A, Batey R, Salmelainen P: Comparing overdose mortality associated with methadone and buprenorphine treatment. Drug Alcohol Depend 2009, 104(1-2):73‑7.

    9.       Soyka M, Träder A, Klotsche J, Backmund M, Bühringer G, Rehm J, et al: Six-year mortality rates of patients in methadone and buprenorphine maintenance therapy: results from a nationally representative cohort study. J Clin Psychopharmacol 2011, 31(5):678‑80.

    10.       Uosukainen H, Kauhanen J, Bell JS, Ronkainen K, Tiihonen J, Föhr J, et al: Mortality among clients seeking treatment for buprenorphine abuse in Finland. Drug Alcohol Depend 2013, 133(2):391‑7.

    11.       Nordmann S, Frauger E, Pauly V, Orléans V, Pradel V, Mallaret M, et al: Misuse of buprenorphine maintenance treatment since introduction of its generic forms: OPPIDUM survey. Pharmacoepidemiol Drug Saf 2012, 21(2):184‑90.

    Competing interests

    None of the authors have any competing interests.

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