TREATMENT SHORTAGE FUELS DRUG DIVERSION

As two of the French experts interviewed for The Sun's recent series
on buprenorphine, we were dismayed that the major public health
benefits of French policy were not properly reflected ("The 'bupe'
fix," Dec. 16-Dec. 18). We feel that the response by The Sun's public
editor to the criticism of the series by several leading public health
professionals demonstrates a continuing disregard for the evidence
("How Sun took on bupe," Dec. 23). In 1994 in France, heroin overdoses
claimed more than 500 lives - most of them injecting drug users who
often shared needles. Opioid substitution treatment and needle
exchange programs were not available.

In 1995, France began a comprehensive harm reduction program,
including drug user outreach and education, needle syringe exchange
programs and the rapid expansion of opioid substitution treatment,
mainly through making buprenorphine part of primary health care
(funded through national health insurance).

Opioid substitution treatment now covers about 70 percent of drug
users in France, and most receive buprenorphine. This change in policy
has achieved:

. An 80 percent reduction in heroin overdose deaths (from 500 to 100
per year).

. A 75 percent reduction in HIV prevalence among drug users (from 40
percent in 1995 to 11 percent in 2004).

. A 75 percent reduction in drug-related crimes.

While France was rapidly expanding buprenorphine treatment, inadequate
access to opioid substitution treatment was the rule in many European
countries. The size of the black market for buprenorphine in these
countries is an indication of the very large number of drug users who
badly want effective drug treatment but are unable to obtain it.

As in many other countries, the risk of buprenorphine diversion exists
in the United States because of the grossly inadequate access to drug
treatment.

Indeed, the more access to opioid substitution treatment is
restricted, the higher the risk of its diversion.

If the U.S. further restricts access to buprenorphine because of
potential abuse, even more people will suffer.

The French experience shows that harm reduction slows the spread of
HIV and reduces heroin overdose deaths and drug-related crime.

The U.S. could learn from the experience of France and many other
countries.

Patrizia Carrieri and Beatrice Stambul

Marseille, France

The writers are, respectively, a researcher at the French National
Institute of Health and Medical Research and the president of the
French Harm Reduction Association.