Practical reflections on the misuse of drugs

The drugs most diver ted for toxicomanic use from their therapeutic indicat ion are principally the opioids or related substances, with codeine still h igh in importance, in spite of the wide prescription of substitution treatm ents. The psychotropic drugs, essentially the benzodiazepines and the stimu lant antidepressants such as amineptine, are also frequently used. The mark et withdrawal of amineptine should diminish its misuse. The abuse of amphet amines-anorectics and barbiturates seems to be regressing. Nevertheless, su bstances such as nitrous oxide and ketamine are the subject of selective, r ecent misuse. Moreover high-dose buprenorphine misuse, as a concomitant bup renorphine-benzodiazepine combination and/or an intravenous injection of hi gh doses of buprenorphine, can be implicated in severe adverse effects. Twe nty-one one lethal intoxications linked to such drug misuse have already be en reported. However, the addictive drug potential is not the only explanat ion for drugs diverted for toxicomanic use. II is also associated with a po lytoxicomania, a symptom of pre-existing difficulties, particularly familia l, social and environmental in origin. Therefore, the therapeutic regime sh ould be adapted to the drug addict's personality. We report a few cases of polydrug abusers, treated with methadone in a specialist unit. The misuse a nd the practical therapeutic response, adapted to each case, are compared a nd discussed in respect of the data published in the literature.