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Évaluation de l’intérêt du sevrage dans le traitement des dépendances aux opiacés

Abstract : General practitioners (GPs) regularly see patients who are dependent on opiates consumed in the form of illicit substances, substitution treatments (OST) (methadone, buprenorphine) or analgesic drugs. This study is composed of two parts: a systematic literature review and a qualitative study using semi-structured interviews with GPs. The systematic review of the literature revealed the following: - show a consensus on the treatments that can be used for acute withdrawal. The treatments include alpha2adrenergic drugs associated with symptomatic treatments. Naltrexone is sometimes added to these treatments, - define the profile of patients eligible for outpatient withdrawal and its contraindications, - underline the need for psychosocial support initiated from the acute phase and continued in the medium and long term, as well as the importance of support from patients' associations. In the qualitative study we carried out, general practitioners emphasized the difficulties in carrying out withdrawal in outpatient primary care, due to the specificities of the approach to opiate-dependent patients; the inadequacy of multidisciplinary and multi-professional support structures and the predominant place occupied by OST. These two studies conclude that withdrawal has taken a back seat to substitution therapies. While the literature reports the emergence of new forms of addiction to synthetic opiates prescribed as analgesic treatment, general practitioners' perception of this new form of addiction remains tenuous. They underline the lack of resources, both in terms of the structures and the staff involved, to carry out withdrawal and the lack of sufficient and appropriate information on the care systems dedicated to withdrawal. The addiction care structures must be reconsidered in order to enable withdrawal to be carried out. It would appear necessary to strengthen the medical and social, inpatient and outpatient support system dedicated to the withdrawal of opiate-dependent patients. The dominant element is the strength of doctors' proposals. They suggest a new organization of addictological care, mainly with the development of multi-professional outpatient microstructures within practices. Their deployment and evaluation appear to be a priority in the care of opiate-dependent patients. Patients' associations must be involved in this system. The proposal to prescribe physical activity adapted to these patients must be given full attention as part of a global approach to patient health. It seems essential to consider training doctors in withdrawal methods and new forms of addiction. The identification of accessible patient profiles for withdrawal is necessary to avoid the systematic proposal of substitute products. They suggest that sufficient time should be made available for the specific care of dependent patients in withdrawal support. The prescription of an OST requires a consultation time compatible with an outpatient general medicine consultation. It seems necessary to consider a fixed amount for the implementation of withdrawal. General practitioners are asking for a system of peer support and assistance to be set up within a mutual aid organization by the council of the order when they find themselves in difficulty in caring for a dependent patient. This work concludes that it is necessary to reconsider the addictology organization in outpatient medicine in order to be able to respond to withdrawal requests. Accompanying withdrawal justifies a specific budget and dedicated structures. The health, economic and societal benefits of withdrawal in opiate addicts need to be evaluated in relation to the benefits of substitution.
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https://hal.univ-lorraine.fr/tel-03356836
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Submitted on : Tuesday, September 28, 2021 - 2:32:49 PM
Last modification on : Wednesday, September 29, 2021 - 3:20:03 AM
Long-term archiving on: : Wednesday, December 29, 2021 - 6:37:31 PM

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  • HAL Id : tel-03356836, version 1

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Paolo Di Patrizio. Évaluation de l’intérêt du sevrage dans le traitement des dépendances aux opiacés. Médecine humaine et pathologie. Université de Lorraine, 2021. Français. ⟨NNT : 2021LORR0109⟩. ⟨tel-03356836⟩

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