[Persistent injecting practices in subjects on methadone or buprenorphine maintenance therapy. A study of 600 cases]

A descriptive study conducted at the Louis-Harris Institute enrolled 600 patients taking methadone or buprenorphine (Subutex((R))) substitution therapy who were followed by general practitioners or specialists working in specialized clinics. The objective was to look for factors correlated with persistent injecting practices. Several factors were found to be statistically correlated with persistent injecting practices: impulsiveness, depressive state, and relative under-dosing (first daily or globally) in patients on Subutex((R)). Considering these factors, a better psychosocial impact could be achieved by providing sufficient attention to anxious or depressive states aggravating the effects of impulsiveness (co-usage of certain substances, psychotonics, search for certain psychopathological states) and paying special attention to the more impulsive subjects. Optimal coverage with earlier orientation to appropriate psychiatric care requires a team effort including educators, social workers and healthcare professionals. Such measures must be conducted within the framework of good clinical practices to establish a coherent multidisciplinary healthcare scheme which should help eliminate this source of more or less overt somatic complications. Such good clinical practice could also facilitate safe extinction of the conditioning inferred by addicted behavior (persistent injecting practices) which could persist only a few months after the end of the stimulus (cessation of emotional pain).