Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients?

France was the first country to promote the extensive use of buprenorphine for the treatment of drug-addicted subjects through the primary care system . To assess both professional commitment and patients' characteristics, all the physicians and pharmacists of a French area having prescribed/dispense d buprenorphine from 2/12/96 (the official release date) to 1/31/98 were id entified from data files of the Health Insurance and then interviewed. Duri ng the first 61 weeks of buprenorphine maintenance treatment (BMT), 27.5% o f physicians and 51.2% of pharmacists of that area were involved; 142 patie nt records were documented. Features of the clinical routines spontaneously implemented for practice-based BMT were: a high level of on-site supervise d dispensation by the pharmacist (71% at treatment induction and 23% therea fter); the absence of objective measurement of illicit drug use; and a low buprenorphine dosage. These features are consistent with the lack of physic ians' experience and training, and also the relatively good status of the p opulation treated (no HIV-positives, heroin use duration averaging 4.2 +/- 3.1 years, and 81.7% with stable accommodations). Despite liberal regulatio ns guiding BMT, a negligible proportion of cases had a "nomadic" attitude ( multiple buprenorphine prescribers/deliverers). The treatment outcomes (no deaths, three drug overdoses, improvement in occupational status) are encou raging. Conclusion: Practice-based BMT appears to be a safe and acceptable response to moderate heroin addiction, but further training of the professi onals involved and longitudinal investigations of individual outcomes are n eeded. (C) 2001 Elsevier Science Inc. All rights reserved.