The treatment of heroin addiction in France relies on either general practitioners (GP) or specialist Addiction Centres (ACs). In general, the GPs offer a more flexible approach regarding frequency of consultations, urine tests and dosing regimen while the AC approach is more structured. A cohort study was undertaken to compare the treatment strategies of buprenorphine therapy between these medical environments. To determine the efficacy of each treatment, a number of outcomes were measured including the Addiction Severity Index, retention rates at 90 and 180 days, the average dose prescribed, quality of life assessment, body weight and two self-reported measures: treatment perception and predictive total duration. A total of 69 patients were enrolled; 32 treated by GPs and 37 treated in ACs. Significant differences, including average age, addiction severity and employment status were apparent between each group. Nevertheless, significant improvements in the social and medical status were observed in all patients after 3 months, continuing after 6 months in both groups. Treatment retention was good in both groups with 65% of the total sample remaining after 180 days. The usually more flexible GP approach was more rigid in this study, resulting in an equally positive treatment outcome as seen in the ACs. The study highlights the effectiveness of buprenorphine in addicts with different social and medical backgrounds, regardless of the therapeutic approach.