Les traitements de substitution aux opiacés en France

France has been implementing a harm reduction based policy toward drug users, mainly based on opiate replacement therapy. The opiate substitution treatment appeared at the beginning of 1990's and was implemented at a large scale to avoid the spread of HIV among injecting drug users and to reduce the large number of drug abuse related deaths. The 15-year experience is conclusive when access to health care had been greatly improved. Moreover, this policy has made a considerable impact on substance users' health in general. It has contributed to the reduction of fatal overdoses, almost brought an end to HIV transmission through needle-sharing; the numbers of offenders for heroine use dramatically decreased. In the same way, adverse consequences occurred, mainly linked to the misuse of buprenorphine. Policy measures have been set up at the end of the consensus conference on June 2004: a national health insurance action plan - aiming at reducing the volume of diverted medicines -, a working group dedicated to opiate replacement therapy on behalf of the Ministry of Health (commission on addiction), regulatory measures to reduce the misuse of opiate maintenance medicines, risk management plan of the French Medicines Agency. The Government Action Plan 2008-11 on drugs and drug addiction provides for proposals aiming at reducing the diversion and the misuse of medicines and protecting their therapeutic value. French advocacy in favour of opiate replacement therapy remains a national and international priority.