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Drug dependence induced by a prescription for long-term opiate treatment : reflection on two cases Volume 94, issue 10, Décembre 2018

Authors
1 Assistante au Certa Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800 Villejuif, France
2 Médecin responsable de l’addictologie au Département de psychiatrie de l’adolescent et de l’adulte jeune du Pr Corcos, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France
3 Consultation Jeune consommateur du CSAPA Émergence Tolbiac 75013 Paris
* Correspondance

Introduction : Concerning two patients, we are studying the drug dependence induced by the prescription of Level III opioid analgesics.

Observation : Referred to the ELSA team at the Institut Mutualiste Montsouris, in Paris, for difficulties in withdrawing from opioid treatment, these patients presented clinical manifestations suggestive of a substance use disorder despite that they were only therapeutic doses.

Discussion : The scientific literature is disparate as to the risk of developing dependency following the prescription of opiates. Screening and surveillance tools have been developed to identify these situations. These two patients were not considered at risk, hence the hypothesis of emotional dependence. In one of the situations, the differential diagnosis of pseudo-addiction may be questioned.

Specific point : In view of the lack of consensus on the management of these patients, and after a failure of opioid withdrawal, the implementation of substitution treatment was decided, as well as psychotherapeutic work.

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