Substitution treatments for drug abusers

Analyzing proposed treatments: The large body of literature on substitution treatments for drug abusers describes a variety of social settings and an extremely heterogeneous set of protocols. Establishing correlations between protocols and practical applications is thus a difficult task. Methadone: The most widely studied substance is methadone. With methadone t reatment there is a decline in the amount of heroin used and in the number of injections. But there is no response with other drugs, leading to a real risk of increasing cocaine abuse. Methadone is used as a tool to decrease the risk of HIV although its impact is difficult to quantify. The most sign ificant effect of methadone treatment is the social effect with a decrease in delinquency and in the number of drug-abuse related incarcerations. The consequences in terms of employment are less clear and vary depending on th e social setting. The therapeutic window is Very narrow with methadone and results are highly dependent on practical applications. A multidisciplinary and individualized approach is required. Buphrenorphine: There has been less work on buphrenorphine, Like methadone, there is a dose/efficacy relationship. The results of comparative studies between the two agents are quite similar with a possible advantage for buph renorpbine because of the wider prescription spectrum and the possibility o f longer intervals between administrations. Extrapolating models: The implications of applying models developed in othe r countries to the social context in France still have to be analyzed on a scientific basis. New trial methodologies are needed to evaluate the social and psychological impact of individualized management.