To the Editor: Because buprenorphine has only partial opioid agonist activity and thus has a lower risk of overdose,1 it may be an alternative to methadone in the treatment of heroin dependence. Buprenorphine has been used for this purpose in France, where general practitioners have been permitted to prescribe it since 1996 with less monitoring than methadone, which is available only in specialized treatment centers.2 Buprenorphine thus has theoretically more risk of adverse effects and increased diversion than methadone. We computed the death rate from overdose of buprenorphine and methadone in France from 1994 to 1998.
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