The United States has a fairly permissive take-home policy, letting doctors prescribe at least a month's supply, among the largest anywhere. By contrast, in Germany unsupervised dosing is not the norm. There, some patients are permitted a week's worth of take-home doses but only after showing compliance for six months.
In France, illegal sales persist despite law enforcement efforts. Over the past year, police have arrested 30 people in a Subutex ring, including a Tunisian man who had nearly 40 prescriptions for the drug. They were from the same doctor, about half filled out in the name of a single patient, said Commissioner Roland Desquesnes of the Brigade des Stupefiants, the anti-drug unit. The physician, who was among those arrested, had sold them for $30 to $45 apiece.
France is also an international hub of Subutex trafficking, a source of the drug in Finland, Georgia and the Czech Republic, according to officials in France and in several countries.
"I think that some percentage of [France's] Subutex comes straight to our country," said Khatuna Todadze, director of a methadone maintenance program at the Georgian Institute of Addiction. "Our problem depends on their system. It's too liberal. Maybe it's good for their patients, but it must be more controlled."
Authorities in Mauritius say they have traced large amounts of illegal Subutex to France, such as the 50,000 tablets brought to the island in May by a French steward for Air France.
It is a profitable trade. In France, an 8-milligram Subutex tablet costs the equivalent of $4 to $8. In Finland, it goes for at least $50. In Georgia, where experts say it has surpassed heroin in popularity, it sells for $100 or more per pill.
"It's more lucrative than heroin," said Desquesnes. "People are very interested in dealing it, and in France, it's very easy to get."
Schering-Plough, the distributor, has come under fire from critics who say it has done little to discourage abuse and illegal diversion of a drug that makes money. The company says that its employees take security seriously, and that "we control the product when it's in our hands."
The company has suggested ways to reduce trafficking, including "reinforcing surveillance" and training doctors better, according to Arens-Richard of the French Health Products Safety Agency.
"Schering-Plough is actually training a lot of doctors," she said, "but it hasn't reduced the misuse of the drug."
Lafforgue, the general practitioner from Toulouse, doesn't see buprenorphine as a solution to opiate addiction.
"We've made drug users addicted to Subutex because it calmed them down," she said. "We've cleaned up the country, but we haven't solved the problem of drug abuse."
Sun reporter Fred Schulte contributed to this article.