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Remboursement des médicaments de substitution aux opiacés chez les militaires en 2007

Reimbursement of opiate substitution drugs to militaries in 2007

Doi : 10.1016/j.encep.2011.11.010 

F. d’Argouges, G. Desjeux  , P. Marsan, V. Thevenin-Garron

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Résumé

L’objectif de l’étude est d’analyser les remboursements de buprénorphine haut dosage et de méthadone, effectués au cours de l’année 2007 par la Caisse nationale militaire de Sécurité sociale au profit des militaires d’active. Il était observé 181 consommateurs militaires de médicaments substitutifs aux opiacés (MSO) soit 167 hommes et 14 femmes répartis dans l’ensemble des trois armées, de la gendarmerie et des formations rattachées. L’âge moyen des consommateurs était de 26,6ans. L’ancienneté moyenne de service était de 6,1ans. La prévalence de la consommation des MSO chez les militaires (52 p. 100 000) est faible par rapport à la population générale. Selon les critères du Plan national inter-régimes de l’assurance maladie pour la lutte contre les fraudes, cette population n’est quasiment pas concernée par les actions prioritaires prévues par le plan. Les médecins généralistes sont les prescripteurs de MSO dans 88 % des délivrances. Un seul prescripteur militaire a été identifié. On a observé que le médecin militaire est mis quasiment systématiquement en dehors du processus de substitution. C’est seulement au terme d’une analyse approfondie de la situation de l’individu concerné que la décision d’aptitude à un poste donné pourra être prise.

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Summary

Introduction

The use of psychoactive drugs by militaries is not compatible with the analytical skills and self-control required by their jobs. Military physicians take this problem into consideration by organising systematic drugs screening in the French forces. However, for technical reasons, opiates are not concerned by this screening with the agreement of the people concerned. The estimated number of militaries who use an opiate substitute may be an approach of heroin consumption in the French forces. This study describes buprenorphine and methadone reimbursements made during 2007 by the national military healthcare centre to French militaries.

Material and method

Each French soldier is affiliated to a special health insurance. The national military healthcare centre has in its information system, all the data concerning drug reimbursement made to French military personnel. This is a retrospective study of buprenorphine and methadone reimbursements made during 2007 by the military healthcare centre, to militaries from the three sectors of the French forces, and from the gendarmerie and joint forces. Only one reimbursement of one of these two drugs during this period allowed the patient to be included in our study. Daily drug dose and treatment steadiness profile have been calculated according to the criteria of the French monitoring centre for drugs and drug addiction. The criteria of the National guidelines against frauds have been used to identify misuse of these drugs. Doctors’ shopping behaviour has also been studied. Finally, the nature of the prescriber and the consumption of other drugs in combination with opiate substitute have been analysed.

Results

One hundred and eighty-one military consumers of opiate substitute drugs (167 men and 14 women) participated. This sample included people from the three sectors of the French forces as well as from the gendarmerie and from the joint forces. The average age of the consumers was 26.6 years (20–42 years). The average length of service was 6.1 years (maximum 22 years service). One hundred and fifty-nine militaries had been delivered buprenorphine, 15 had been delivered methadone and seven had been delivered both. The prevalence of opiate substitute drug consumption by the militaries (52 per 100,000) is lower than in general population. According to the criteria of the National Healthcare Insurance, this population is not affected by abuse or fraud behaviour. Doctors’ shopping behaviour is unusual. Opiate substitutes are prescribed by general physicians in 88% of issues. Only one prescriber was a military physician. An analysis of reimbursement of some drugs associated with opiate substitute has been made. The sampled military consume more psychoactive drugs (anxiolytics, antidepressants, hypnotics) than the French population under opiate substitution.

Conclusion

In our observation, the military physician is almost always excluded the process of substitution. His/her different responsibilities of care, but also in determining the working aptitude, lead to dissimulation behaviour by the militaries. The difficulty for military physicians is to identify such consumption. They have to evaluate the capacity to work through a physical and psychological examination.

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Mots clés : Dépendance à l’héroïne, Buprénorphine, Méthadone, Militaire français, Aptitude au travail

Keywords : Heroine dependence, Methadone, Work capacity evaluation, Buprenorphine, French military personnel


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© 2011  L’Encéphale, Paris. Publié par Elsevier Masson SAS. Tous droits réservés.
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