[High dosage buprenorphine and injection practices. A study of 303 patients]

In France, by the end of 1999, a study of a naturalistic-type was led by the Louis-Harris Institute on 303 persons taking high dosage (HD) buprenorphine. This study aimed to identify factors likely to be correlated with stopping or continuing HD buprenorphine injections. We carried out a comparative study of four groups of HD buprenorphine users: "non-injectors" (n=90), "ex-injectors" (n=71), "monitored injectors" (n=69) and "un-monitored injectors" (n=72), with intra-group representativeness. The data was gathered in the context of anonymous interviews, by objective interviewers, in 20 regions. Most of the interviewees were also users or ex-users of more than one psychoactive substance. The "un-monitored injector" group was younger than the "non-injector" group and not as well integrated into society. The injection frequency was lower in patients receiving medical care. Research into the reasons for stopping and cutting down on HD buprenorphine injections revealed indicators such as the impossibility of breaking the injection habit, the fact that users seek the immediate sedation effect, and associating with friends who also inject. These factors seem to be greatest during critical periods, such as depression or the absence of well being. We showed that the factors involved in cutting down included: revaluation of the way in which the medicine was taken with the doctor, and becoming aware of the problems resulting from injection through information received from the doctor and/or by experiencing problems firsthand. In all the groups, the benefits associated with taking HD buprenorphine were observed and evaluated, starting with a list of 14 items. Five main benefits were found: cutting down on or stopping heroine, taking better care of oneself, making new plans, being in better physical shape, and finally, sleeping better. The improvement was greatest in the "non-injector" and "ex-injector" groups. The work that would be necessary to establish effective medical support involves a global approach including an appropriate initial prescription, paying special attention during critical periods, and verification of the mode of use so as to avoid under-dosing, and constant evaluation of the risk of resorting to injections. The fact that there are ex-injectors and that some regular injectors have not resorted to injecting during the last month shows the benefits of medical support.