[Opioid substitution therapy in France: a physician's overview]

Widespread diffusion of opiate substitution therapy (OST), particularly with high-dose buprenorphine (BHD) has led to a considerable decline in the number of intravenous drug users (IVDU) in France, in parallel with a reduction in the volume of over-the-counter syringe sales, the number of overdoses, the use of heroin, and the associated delinquency, and HIV prevalence. OST also plays a crucial role in improving observance of anti-HIV, and anti-HCV treatments as well as an improvement in the quality-of-life of IVDUs. But fraudulent behavior (resellers, dealers), and misuse (sniff, inhalation, injection for BHD, fractionated or excessive doses, association with other psychoactive products for BHD and methadone) have also developed. Misuse is related either to the difficult, and progressive adhesion process during the early phases of OST or to a situation of therapeutic failure after long-term appropriate OST. Unless access to care is facilitated with new therapeutic options capable of matching the benefits of OST, healthcare professionals will have little to offer in the event of therapeutic failure.