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• W2089852018 abstract "Sir—While the therapeutic efficiency of drug substitution treatments has been evaluated through randomized clinical trials and convenience sample studies, with social, psychological and clinical monitoring, drug substitution policy has not been fully evaluated in most countries, especially in frontier regions. New trends emerge as new drug users sample various psychotropics without information and caution (EMCDDA 2001), sometimes outside their home region. Drug users living close to frontiers can modify their behaviour according to national drug and substitution treatment policy. In the Francophone community of Belgium, tablets of methadone (MET) have been widely available since 1994 from general practitioners (GPs), while high-dosage buprenorphine (HDB), which possesses both agonist and antagonist activity, has not been available. On the other hand, in France, access to MET has been restricted to drug agencies, while HDB has been widely available through GPs since 1996. We report here a cluster of overdoses related to MET among French drug users living in the North of France, close to the Belgian frontier. In 2000, nine male adults were hospitalized for coma in the intensive care unit (ICU) of Lens hospital, France, with a diagnosis of opiates overdose based upon patient history, clinical report and urinary drug tests for opiates, HDB, MET, cannabis, benzodiazepines, cocaine and amphetamines, which were performed in a specialized laboratory. This ICU is the only one in the district of Lens (population around 400 000), situated in the north of France, 30 km from the Belgian frontier. There is only one drug agency in this district. All nine cases were positive for urine MET testing; six were also positive for opiates, three for cannabis, two for benzodiazepines and one for alcohol. The Belgian origin of MET was confirmed by interviews with the patients and/or their relatives and/or friends. Five cases had an episode of pneumopathy and two had an episode of rhabdomyolisis. One patient, aged 19, died; he was not known as an opiate addict but had taken several tablets of Belgian MET with different dosing (60, 80, 100 mg). Overdoses occurred in young polydrug users (median age 24) who had not been prescribed MET in the local drug agency. The opiate status was not known for one patient. Two patients on HDB were supervised by French GPs, and had not taken their treatment for several days. Two others were on MET and were followed up by Belgian GPs. Three patients were occasional or ex-opiate users, of whom one had just been released from prison. One was not an opiate user. The young age of patients in our study must be highlighted: other studies reported mean ages of 28–31 years among death cases (Kringsholm et al. 1994; Scott et al. 1999; Perret et al. 2000; Gossop et al. 2002). In our sample, all overdoses were related to diverted or unsupervised MET, which confirms previous results about the high risk of overdose with diverted MET (Cairns et al. 1996; Zador & Sunjic 2000). In 1998, four MET-related deaths occurred in France among the 5360 patients on MET, corresponding to a yearly death rate at least three times greater than that related to HDB (Auriacombe et al. 2001). In 2000, 11/120 (9.2%) of lethal overdoses related to MET were reported by the French Monitoring Centre for Drugs and Drug Addictions from police units providing toxicological analysis. The lack of supervision and the diversion of MET among reported cases can be related to the proximity of a health district where MET is offered without tight control: this attracts drug users living on the other side of the frontier. In contrast, no overdose occurred among patients who were on either MET or HDB maintenance and were supervised by the local drug agency. Finally, in spite of the large proportion of opiate-dependent persons on BHD maintenance treatment in the Lens district (65% vs. 8% on MET), neither hospitalization nor fatality was reported in the ICU within the same period due to concomitant intake of HDB and benzodiazepines. In conclusion, although the impact of methadone on morbidity in opiate users has been evaluated positively in trials, its misuse in ‘real life’ should not be neglected, especially in the context of frontier regions with different national regulations. Wide access to MET without the tight supervision of patients and appropriate training for physicians is likely to increase the number of overdoses and deaths among young new drug users. These people should be clearly informed by physicians and drug agencies about the risk of MET as an occasional and recreational drug, especially in frontier regions. In the expectation of a drug policy harmonization in Europe, local authorities should elaborate common strategies and implement networks between physicians and drug agencies who practise on either side of frontiers." @default.
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• W2089852018 date "2002-08-30" @default.
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• W2089852018 title "A Cluster of Nine Overdoses (One Fatal) Related to Methadone in the North of France: A Lesson for Drug Policy in Frontier Regions" @default.
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• W2089852018 doi "https://doi.org/10.1046/j.1360-0443.2002.00223.x" @default.
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