[Management of drug addicts (heroin addicts) by general practitioners]

A telephone survey has been undertaken in a random sample of 150 General Practitioners (GPs) in four regions of France. 25% refused to answer. The study showed that drug addiction (use of heroin) is a serious issue for many of these physicians: 15% follow more than 20 drug addicts per year and only 12% see none; extrapolating the mean number of drug addicts followed yearly (9.4 per GP) to all GPs in the four regions (26,000, that is to say half of all french GPs) give an "active file" of 250,000 drugs addicts per year. Only 15% if the GPs feel they are educated for the management of drug addicts, although 70% say they prescribe medication such as hypnotics and anxiolytics (97%), the most cited being Tranxene 50 (Chlorazepate 50 mg), antalgics (84%), morphinic or morphine-like drugs (49%), mainly Temgesic, and at last antidepressants and neuroleptics (39%). GPs suffer from being isolated in their practices, as contacts with collegues or institutions specialized in drug addiction are few. If one third of the GPs wish an active participation in the management of drug addicts, and one third wish at least to "do something", they are all much ambiguous in their attitudes toward drug addiction. Their behaviors vary from medical pride to anxiety and even fear. They all mention a lot of practical problems with respect to reputation, practice, lack of time... Unanimous wishes concern opportuneness of setting up continuous medical education on this topic, of working out guidelines for prescription, of improving relationships with other institutions.