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• W1975939972 abstract "Methadone is prescribed in France as a maintenance treatment for heroin dependence since 1969. Nevertheless, the optimal duration of methadone maintenance treatment and how detoxification from methadone at the end of the treatment should be performed is still discussed. To conduct a literature review on when and how detoxify clients from methadone maintenance treatment and to collect the opinion of experts in the field. We searched the PubMed, Embase, Cochrane Library and PsycINFO databases on the 1966–2011 period using the keywords “methadone”, “maintenance”, “detoxification”, “tapering”, “cessation”, “withdrawal”. We also searched data in other addictive journals in French that are not available in those databases. We also collected the opinion of the physician in charge of the oldest methadone program in France (1969). We excluded studies that used methadone as short time treatment of heroin withdrawal and thus selected 23 articles. There is a consensus on when methadone maintenance treatment should be stopped, defined by the client's will to stop, the judgement from the physician that the client has been stable for a period of time that is long enough, but also the client's motivation to live his life without maintenance treatment. There is also a majority, among articles on how methadone treatment should be stopped, recommending ambulatory, practical approaches using slow tapering of the dose, with the ability to go back to the previous dose if needed, namely in case of relapse to heroin use, heavy withdrawal or psychiatric symptoms. There are few articles addressing the subject, especially comparing prospectively different cessation strategies. Methadone maintenance treatment should not necessarily be maintained all life long and can be stopped within its prescription setting, including medical, psychological and social evaluation. La méthadone est utilisée en France dans l’indication de traitement de substitution de la dépendance aux opiacés depuis 1969. Néanmoins, la durée pendant laquelle ce traitement doit être maintenu et ses modalités d’arrêt sont imprécises. Conduire une revue de la littérature sur le moment et les stratégies d’arrêt du traitement de substitution par méthadone et recueillir des opinions d’expert. Nous avons conduit une recherche PubMed, Embase, Cochrane Library et PsycINFO sur la période 1966–2011 en utilisant les mots clés methadone, maintenance, detoxification, tapering, cessation, withdrawal et dans des revues d’addictologie françaises non indexées. Nous avons également recueilli l’opinion du médecin responsable du centre de soins ayant la plus longue expérience de prescription de méthadone en France (depuis 1969). Nous avons exclu les études qui envisageaient la méthadone comme traitement bref du sevrage en opiacés et retenu 23 articles. Il existe un consensus sur le moment où l’on peut arrêter le traitement par méthadone, déterminé par le volontariat du patient, l’appréciation par le clinicien que le patient est stable depuis une durée suffisante mais aussi la motivation du patient et sa capacité à concevoir sa vie future sans substitution. De même, il existe une majorité d’articles prônant des modalités d’arrêt fondées sur des approches pragmatiques, utilisant des décroissances progressives, en ambulatoire, avec possibilité de retour en arrière en cas d’apparition de consommations d’héroïne, de symptômes de sevrage, ou de symptômes psychiatriques. Le nombre d’article est limité et nous avons trouvé peu d’études prospectives comparant différentes stratégies d’arrêt. La substitution n’est pas forcément un traitement à vie pour tous les patients et son arrêt peut être envisagé au sein du cadre de prescription c’est-à-dire accompagné d’un suivi médical, psychologique et social." @default.
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• W1975939972 date "2013-01-01" @default.
• W1975939972 modified "2023-10-18" @default.
• W1975939972 title "Stratégies d’arrêt du traitement de substitution par méthadone" @default.
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• W1975939972 doi "https://doi.org/10.1016/j.lpm.2012.04.011" @default.
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