Use and Misuse of Opioid Replacement Therapy in France Essay

Use and Misuse of Opioid Replacement Therapy in France Essay

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DISCUSSION
A cohort from French National Healthcare Insurance Database named EGB allowed identifying patients with health care consumption related to ORT in 2006–2012. There are some limitations in the use of this medico-administrative cohort. Some categories such as students and civil servants benefit of specific healthcare insurances and are not included in the EGB cohort. Drug users are frequently in precarious situation and are automatically affiliated to a free complementary Universal Health Insurance (“CMU”) for delivery of ORT; therefore, they are probably overrepresented in EGB. In contrast with HDB that is most frequently delivered in retail pharmacies, early treatment with methadone is frequently directly obtained in hospital pharmacies or in centers specialized in the treatment of drug abuse. These deliveries are not reported in EGB. Our results provide nevertheless an overview of the delivery of methadone through retail pharmacies. There are also limits related to the real consumption of patients. For example, a patient who seems to receive high doses of ORT may sell a part of the reimbursed drugs; conversely, some patients may obtain ORT from the illicit market.
According to our results, the population treated with ORT steadily increased: from 1014 patients in the cohort in 2006 to 1211 patients in 2012. Male gender was predominant (three men for one woman) and mean age was 34 years at initiation of ORT. HDB remained predominant among reimbursed ORT; however, the part of methadone steadily increases from 20% in 2006 to 32.5% in 2012. These results on patient characteristics and evolution of methadone use confirm recent published data [1, 12, 13].
One of the objectives of the study was to evaluate the risk of misuse th...


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[12] Brisacier A-C, Collin C. Données récentes relatives aux traitements de substitution aux opiacés - Analyse des données de remboursement concernant l’échantillon généraliste des bénéficiaires en 2011, OFDT, 2013, Saint-Denis, 45 p.
[13] Canarelli T, Coquelin A. Données récentes relatives aux traitements de substitution aux opiacés : analyse de données de remboursement concernant un échantillon représentatif de patients en 2006 et en 2007. Rapport OFDT. Décembre 2010.
[14] Recommandations pour la pratique clinique. Réduire les mauvaises utilisations des médicaments de substitution des opiacés. Juin 2004. http://www.has-sante.fr/portail/upload/docs/application/pdf/opiaces_recos.pdf.
[15] Yokell MA, Zaller ND, Green TC, Rich JD. Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review. Curr Drug Abuse Rev 2011;4:28-41.

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