Two years follow-up of heroin users treated by GPs with high dosage buprenorphine: the SPESUB study (pharmaco-epidemiological follow-up of high dosage buprenorphine in general practice)
A. Duburcq et al., Two years follow-up of heroin users treated by GPs with high dosage buprenorphine: the SPESUB study (pharmaco-epidemiological follow-up of high dosage buprenorphine in general practice), REV EPIDEM, 48(4), 2000, pp. 363-373
Background: Since February 1996 French GPs are allowed to prescribe high do
sage buprenorphine for maintenance treatment of major opioid drug addiction
. A prospective cohort of major opioid addicts was initiated in order to as
sess patient outcomes: follow-up, retention rate in treatment, drug use, in
travenous injection and social situation evolution.
Methods: Each GP, known to be involved in drug user management, had to incl
ude the first 10 opioid drug addict patients to whom he prescribed high dos
age buprenorphine, with a maximum inclusion period of 3 months. Patients we
re followed up for two years and a regular standardized information was col
lected (usual data on drug users and prescription modalities).
Results: Between May and July 1996 919 patients (664 men and 255 women, mea
n age: 30 years) were included by 101 GPs. They had a long and serious hist
ory of drug addiction, important parallel consumption of cocaine, codeine a
nd other illicit drugs and psychiatric problems (28% of definite problems a
nd 45% of probable) and frequent hepatic conditions (hepatitis B: 23%, hepa
titis C: 21%). Two years later, 55% of patients were still followed-up by t
he same GP and an additional 12% were followed by another GP or in a health
care service (hospitalized or receiving methadone in a specialized centre)
. 13% were not followed, but GPs were able to describe their situation. 8%
had been included by GPs who had dropped the study. Finally, 12% of patient
s were lost to follow-up. Among the 508 patients still followed-up by the s
ame GP after 2 years, the substitution treatment rate was 84%. The dosage b
racket had widened (inclusion: mean dosage = 7.8 mg +/-4.5, minimum = 0.8 m
aximum = 28 median = 8; after 2 years: mean = 7.6 mg +/-5.4, minimum = 0.4,
maximum = 28 median = 8) and the duration of the prescription and dispensi
ng had increased. Declaration of heroin intake in the previous month had fe
ll from 40% to 11% and declaration of drug intake from 53% to 20%. Social s
ituation had improved on average (housing conditions and work). There were
12 seroconversions for hepatitis B, 21 for hepatitis C and 4 for HIV. 14% o
f patients had declared intravenous injection of high dosage buprenorphine
in the previous month.
Conclusion: After two years of follow-up, 55% of patients were still follow
ed-up by the same GP and an additional 12% was followed by another GP or in
a health care service. Among patients still followed up by the same GP, a
reduction of drug related harm (seroconversions for hepatitis B, hepatitis
C and HIV) was observed.