Dépendance aux opioïdes en médecine de premier recours

Opioid addiction constitutes a major public health issue. Its management relies on opioid agonist therapy (OAT), which replaces the illicit consumption to stabilize the dependence. In 2023, 15,707 people with an average age of 49 were receiving OAT in Switzerland. A general practitioner can initiate OAT in most cases. A laboratory assessment and cantonal authorization are mandatory for OAT initiation. Methadone, the main treatment, requires gradual titration (20-30 mg initially and then 60-120 mg for maintenance) with daily monitoring. Adverse effects include constipation, hypogonadism, sleep apnea, and QTc prolongation. Withdrawal is optional and must be gradual over several months or years.