[Methadone and new antiretroviral drugs. Results of therapeutic follow-up].
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Biomedical subjects
Publications and source records attributed to D Touzeau.
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In France, during the 1990s, there have been some rapid developments in the treatment of opioid addiction with the introduction of legal substitution agents. Originally, some patients were treated with morphine sulfate, but this was superseded by high dose buprenorphine (Subutex(R)) and methadone. This resulted in those patients originally treated with morphine being transferred to either of these two licensed products. A study investigating the effects of the transition from morphine to either buprenorphine or methadone was undertaken. Supplementary to this, a trial investigating transition between these new compounds was also conducted. The primary outcome measures for these trials were retention rate, which was assessed at 5, 9 and 12 months, and the precipitation of withdrawal symptoms. The studies showed that transferring patients between substitution agents can be accomplished without severe withdrawal symptoms, although specific management may be required for transfer from high doses of methadone to buprenorphine. High long-term retention rates were observed in the studies, with most drop-outs occurring directly after transfer. Results suggest that patients on long-term buprenorphine maintenance therapy may have good compliance in comparison with other agents.
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In 1986, a national survey was carried out in France among 4846 drug abusers attending specialised agencies and treatment centres. Data are analysed and compared with the results of a previous study in 1972. Most French drug abusers are men (74%) ranged in age from 20 to 29 years (68%). Data suggest increasing problems with heroin (69%), cocaine (13%), solvents (5%), alcohol (26%) and multiple drug dependence. Women are younger, they have attempted suicide more often than men but have been incarcerated half as often. Concerning drug abuse trends, women appear to use increasingly sedatives in combination with other drugs. Partial data concerning HIV seropositivity reveal a rate of 48% among drug abusers having been tested.
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The authors examine three situations in which the physician intervenes between the delinquent and his judge. 1) The Drug Addicts: it is important to distinguish in behavioural disturbances the difference between delinquency and addiction. According to the Law of the 31st of December 1970, the physician becomes an auxiliary to the judicial process. In fact, the opportunity of such an encounter between the physician and the addict can be beneficial to both of them. 2) The juvenile delinquent: The assumed responsibility of the juvenile delinquent falls, on one hand, on the care of his personality, and on the other hand, on his way of life. 3) Article 64 of the Penal Code: this determines the responsibility or the irresponsibility of the delinquent depending upon eventual mental disease. The doctor's position is delicate, in certain cases, it is important to avoid excessive medicalization of a social problem, in others it is necessary to advise the appointment of an expert.
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