MEDICAL TREATMENT FOR OPIOID DEPENDANCY A peaceful revolution

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MEDICAL TREATMENT FOR OPIOID DEPENDANCYA
peaceful revolution
c l i n i q u e m o n t e v i d e o
Institut Baron Maurice de Rothschild pour la
recherche et le traitement des addictions
Dr William LOWENSTEIN CEO of The Clinique
Montevideo The Baron Maurice de Rothschild
Institute for Research and Treatment in
Addictions Member of The board of the National
AIDS council
Beyrouth, Lebanon, october 2005
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What do we want ?
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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If we really want
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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80 decrease in lethal overdoses
Lepère B., Gourarier L., Sanchez M., Adda C.,
Lowenstein W., Reduction in the number of lethal
heroin overdoses in France since 1994. Focus on
substitution treatments, Ann Med Interne, 2001
Apr152 Suppl. 35-12.
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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2.000 decrease in HIV transmission
Ref National AIDS Council, Rapport sur la
prévention Dominique CASTIGLIOLA To be
published in november 2005
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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What about HCV ? Stabilization ?
?
1992
1995
2005
Evolution of HCV treatment among drug users
More than 40 of IV drug users are HCV , Less
than 5 are treated.
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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400 decrease in detention (prison) for heroin
use

• And for the first time
• decrease in Heroin seizure, (and correlatively
  in
• consumption ??)
• Improving of collective safety

Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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Number of heroin dependant users taking benefit
of medical care more than 100.000 patients on
180.000 i.e. more than 50
100.000
52
1991
2005
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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So, if we want all what we just saw
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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ACT PRESCRIBE

• General Practitioners
• Pharmacists
• Actors in charge of Administration and Politics

ORGANIZITION FINANCEMENT INFORMATION
METHADONE CHLORHYDRATE
HD BUPRENORPHINE
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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THE KEY OF SUCCESS OF EFFECTIVENESS
Easy access to neuro-pharmacological treatments
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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THE FALSE DEBATE
Accessibility Effectiveness
Security
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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Decreasing accessibility is not a way to more
security
At the opposite less patients treated less
security
But ? Treatment adaptation (the right
indication) ? Medical Training GPs
Pharmacists Psychologists Persons
in charge of Administration and Politics ? Not
to ask to treatments (Methadone or HD
Buprenorphine) what they cannot make
Increasing security
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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• Maintenance Treatments
• UNDERSTAND Complete success, half success
• Failures, Evolution
• LEARN Treatments associations
• Treatments duration
• MORE. Research
• Training
• International exchanges and communication

Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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Medical effectiveness For a social
peaceful (R)evolution
Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005
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Dr W. LOWENSTEIN Beyrouth, Lebanon, october 2005