Pierre Palmade “was positive for cocaine and substitution drugs” during his car accident on February 10. These treatments are indicated to put an end to the dependence and the consumption of drugs (heroin…).
The comedian Pierre Palmadeinvolved in a serious road accident on February 10, 2023, “was positive for cocaine and substitution drugs” report our colleagues from Parisianobviously referring to opioid substitution treatments (morphine, heroin for example) prescribed to treat a patient’s addiction. What are the substitute drugs authorized in France? Methadone? What are their indications and side effects? Are there any risks of taking them at the same time as drugs? Answers with Dr Margaux Kosim, addictologist.
What are substitute drugs?
When we speak of “substitute drugs” it is generally to designate the opioid substitution treatment (OST). Opiates being the derivatives of opium which comes from the poppy: heroin, morphine, codeine… These treatments have a mechanism of action similar to that of the drug on which the patient is dependent. “These drugs (buprenorphine and methadone) are also opiates, their molecules have the same mechanism of action as heroin, for example by binding to the same receptors” says Dr. Margaux Kosim, addictologist. “In chronic treatment, they are part of a comprehensive care whose objective is the end of addiction and drug consumption. They come in the form of syrup, tablet or injection given daily. We also have available in France a substitution treatment of which the action lasts for a month“adds the addictologist.
In which cases are substitute drugs indicated?
“Substitute drugs are prescribed by a doctor when the patient wants support to stop all drug use, For take control of your life and be rehabilitated in society” emphasizes our interlocutor. They accompany the cessation of opiate intake. “Sometimes, some patients on substitution treatment use drugs at the same time. That is why drug management is indicated in addition to psychotherapist work focused on patient stabilization“says Dr. Kosim.
What is the role of substitution drugs?
Substitution drugs aim to prevent withdrawal symptoms and its side effects such as delirium tremens. We start with high doses which are then adapted according to the symptoms. “Drugs occupy the opioid receptors and through this occupation, the patient will not have the urge, the so-called drug-seeking “craving” and the effect thereof, develops the expert. Heroin had a very short duration of action (“flash” effect), the addict feels the need for it several times a day. The drugs have a longer duration of action that covers the whole day, and only requires daily (or even monthly) intake. So, the treatment stabilizes the person, stops the misuse of the opiate as well as all the consequences in the patient’s life“.
What opioid substitution drugs are authorized in France?
There are 2 drug substitution medicines in France:
- buprenorphine (tablet or subcutaneous injection for sustained release)
- methadone (syrup or tablet)
What is the duration of the substitution treatment?
Taking opioid substitution treatment is first initiated by the patient. “Opiate addiction is a chronic disease with a risk of relapse, treatment is thought out over the long term. Stopping treatment creates a risk of returning to drugs because the brain does not forget the lack” warns the addictologist. Generally, it is not the doctor who decides to stop the treatment but the patient who expresses the will. In this case, it must be accompanied meticulously while keeping in mind the risk of relapse and overdose linked to a new drug intake. Some patients stop treatment after a short time, others keep it over a prolonged period, and the treatment becomes chronic.
Is the substitution treatment taken at home or in the hospital?
During the implementation of the treatment, the patient joins a Addictology care, support and prevention center (CSAPA) or a hospital service. “He is accompanied by a doctor who establishes the most suitable molecule and what dose stabilizes it and prevents cravings. There methadone can only be prescribed by a physician from a CSAPA and issued under prescription. Buprenorphine can be initiated by a general practitioner, preferably an addictologist” defends our interlocutor. Once the patient is stabilized and balanced, the doctor can deliver a treatment prescription for a maximum of 1 month in autonomy (for the tablet form) that the patient will pick up at the pharmacy. For injections, the patient goes once a month to the hospital or in the center. Other patients, less stabilized, go daily to the center to receive their tablet.
Are there substitute drugs for alcohol?
There is no alternative drug to alcohol, the treatment accompanying alcohol withdrawal does not rely on the same mechanism as substitution medication adapted to opiates. “Alcohol cessation is accompanied by hospitalization or outpatient support. To soothe the withdrawal period and prevent the risk of relapse, two drugs are indicated: acamprosate and naltrexone“explains the addictologist. “For alcohol, physical weaning lasts about a week. Maintaining abstinence and psychological withdrawal do not have a predetermined duration, each case is specific. Alcoholism is also a chronic disease with risk of relapse“recalls Dr. Kosim.
What are the tobacco substitute drugs authorized in France?
Nicotine patches or chewing gum are substitute drugs for the addictive substance (nicotine) contained in tobacco.
What are the side effects and contraindications to substitution drugs?
“Side effects are known and manageable (constipation, sweating, headaches…) and the benefit-risk is positive. These treatments have been known since the 90s by medical teams and patients. On the other hand, we face a problem of misuse of substitute tablets: resale, injection, theft etc That is why the prescription is supervised and the autonomy only concerns truly stabilized patients” reports our expert. “The contraindications can relate to one of the two molecules but it is very rare that there is a prohibition unless one very severe liver failure For example” argues Dr. Kosim. It’s more a question of dosage. Pregnancy is not a contraindication substitution treatment, on the contrary. “We closely monitor the pregnant woman and the preparation for childbirth in warning the gynecological teams because the baby will experience withdrawal syndrome. It will then be necessary to provide him with appropriate care.“concludes the addictologist.
Thanks to Dr Margaux Kosim, addictologist from the Pitié-Salpêtrière Hospital Group.