[Changes in high-dose buprenorphine maintenance therapy at the Fleury-Merogis (France) prison since 1996]

Since the law of January 1994, the ministry of Health is responsible for inmate health in France. This law created medical wards inside French prisons by conventions between hospitals and prisons. Since July 1995, Fleury-Merogis state-prison is linked to the Sud-Francilien Hospital. During the last few years, more and more IV drug users have been incarcerated and the number of infectious diseases has increased (AIDS, hepatitis C and B). Risk behavior is rather frequent and it has become a major concern of public authorities to fight this evolution. Prisons are part of structures having to take care of IV drug users. A few months after the authorization of buprenorphine in France (March 1996), the ministry of Health decided to give access to this treatment for incarcerated IV drug users. The aim of this study is to present the evolution of maintenance medication by high dose buprenorphine in a big state-prison and to explain the difficulties we have to face. The aim of this study was also to present how this treatment can contribute to reducing infectious risks. Surveying prescription is under the control of the Pharmacy since 1995. We have studied since 1996 the number of prescriptions, segregating initialized inside the prison and prescriptions continued. We have also studied and evaluated the number of psychotropic drugs for each prescription since 1996 in "two test buildings". Evolution of self mutilations and reducing infectious risks support measures have also been studied.