Addiction: GPs should be able to introduce two alternative treatments

GPs should be able to introduce two alternative treatments under certain conditions, this is one of the main recommendations of the jury of a consensus conference on treatment strategies for opiate addicts.

Alternative treatments are legalized in France for less than ten years and only two drugs, methadone and buprenorphine, have authorization for placing on the market in this indication.

Implementation was carried out in general practice because of the immediate availability of buprenorphine for all GPs, while methadone was primarily intended to be borne by the specialized centers.

Despite the reluctance of the medical profession, the number of patients receiving drug substitution increased from a few dozen to nearly 100,000 nearly two-thirds of people have this type of addiction. Treatments have improved health, reduced consumption of illicit opiates and very significant reduction in the number of fatal overdoses and contamination by the AIDS virus.

But at the same time, these treatments have shown their limits. On the one hand, access to two drugs available is very uneven across geographies and is insufficient for the most vulnerable populations. On the other hand, misuse lead to dangerous practices, including buprenorphine: use intravenous or dangerous combinations with other drugs, in particular benzodiazepines.

Finally, diversions have fostered the development of a black market.

Held in Lyon, a consensus conference brought together experts to speak in front of a jury, allowed to discuss improvements. The French Federation of addiction, promoter of this initiative, which took place according to the methods of the National Agency for Accreditation and Evaluation in Health (Anaes), was particularly questioned the modes of care patients.

The jury awarded the final conclusions, inter alia, that the need to pursue four objectives: to allow the development of alternative treatments, reach more people, give specifiers the choice of the molecule used, strengthen security and finally allow GPs starting treatment with methadone.

Philippe Douste-Blazy, Minister of Health, welcomed the findings. holding that such "substitution policy has proved its effectiveness." It confirms its policy of risk reduction becomes a legal basis under the law relating to public health policy on 9 August 2004.

Some proposals highlighting the need for collaboration between the physician and the pharmacist or the establishment of treatment protocols related to health insurance, also support. They have been the subject of legislation (reform of health insurance).

Finally, it is pleased to see recommended "links between specialized centers, doctors city and structures support the most vulnerable populations."