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Grigg-Damberger M. Is there a better way to wean chronic benzodiazepine receptor agonists use by substituting a DORA (and starting CBT-I)? J Clin Sleep Med 2024; 20:483-485. [PMID: 38321804 PMCID: PMC10985305 DOI: 10.5664/jcsm.11058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/08/2024]
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Laforgue EJ, Rousselet M, Claudon A, Aquizerate A, Jolliet P, Istvan M, Victorri-Vigneau C. Did the New French Regulation of Zolpidem Decrease the Problematic Consumption of Zolpidem? A Field Study among Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158920. [PMID: 35897285 PMCID: PMC9331950 DOI: 10.3390/ijerph19158920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 12/03/2022]
Abstract
Background: The French national drug regulatory authority stated, in 2017, that a secured prescription pad must be used for zolpidem prescriptions. This study aimed to evaluate the evolution of the problematic consumption of zolpidem at the individual level since the new regulation. Methods: Two nationwide populations of at-risk users of zolpidem were recruited: one in general practitioner (GP) offices and one in specialized care centers dedicated to drug dependence (SCDDs). Participants were asked about their zolpidem consumption before and after the regulation change. The primary outcome was the evolution of problematic zolpidem consumption, as defined by at least one of the following criteria: overconsumption, fraudulent ways of obtaining, effects sought other than hypnotic, and modes of administration other than oral. Results: A total of 243 participants were included: 125 from GP offices and 118 from SCDDs. In the GP population, the prevalence of patients who were identified as problematic consumers decreased from 24.8% to 20.8% (p = 0.593), whereas the prevalence decreased from 73.7% to 51.7% in the SCDD population (p < 0.001). The most prevalent criteria for problematic status were overconsumption and fraudulent ways. Conclusions: The new French regulation of zolpidem had different impacts among two different populations of at-risk zolpidem consumers.
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Affiliation(s)
- Edouard-Jules Laforgue
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
- Correspondence: ; Tel.: +33-2–4008-4073
| | - Morgane Rousselet
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, F-44000 Nantes, France
| | - Antoine Claudon
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
| | - Aurélie Aquizerate
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
| | - Pascale Jolliet
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
| | - Marion Istvan
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
| | - Caroline Victorri-Vigneau
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
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Perception of the Regulatory Change for Zolpidem Prescription by French General Practitioners and Its Relation to Prescription Behavior. J Clin Med 2022; 11:jcm11082176. [PMID: 35456269 PMCID: PMC9032177 DOI: 10.3390/jcm11082176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background: To “limit the risk of abuse and misuse” and “encourage correct usage”, the French drug regulatory authority stated that—from April 2017—zolpidem prescription must be performed on a secured prescription pad. This national study aims to evaluate the perception of general practitioners (GPs) towards this new regulation and its link with prescription strategies. Methods: We conducted structured interviews of GPs. Data were collected about GPs’ perception of the measure and therapeutic strategies towards zolpidem. The primary outcome was the description of the GPs’ strategy of prescription, based on the perception towards the new regulation for zolpidem. Results: For 206 GPs, the new regulation was mainly perceived as helpful (61%) and as a difficulty (55%). Other perceptions were the awareness of the risks of zolpidem (18%), awareness of the risks of hypnotics (13%), and nothing changed (5%). Four clusters of GPs were identified. In the clusters with the perception as a difficulty (only or associated with helpful), the GPs who applied the strategy “no modification” for >50% of their patients were more frequently compared to awareness and helpful only clusters (60.8%; 42.9%; 20.4%; 26.7%) (p < 0.001). Conclusions: We highlighted an association between the perception of the new regulation of zolpidem prescription by GPs and a strategy of prescription.
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Jobert A, Istvan M, Laforgue EJ, Schreck B, Victorri-Vigneau C. Regulatory Framework Implementation for the Prescription of Zolpidem in France, What Impact in the Older People? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12099. [PMID: 34831853 PMCID: PMC8619144 DOI: 10.3390/ijerph182212099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND Zolpidem is one of the most prescribed hypnotic drugs. In 2001, the World Health Organization alerted a risk of pharmacodependence associated with zolpidem. The French health authority decided in 2017 to enforce security on the prescription of zolpidem to reduce those risks. The aim of our study was to evaluate the impact of regulatory framework implementation, secure prescription pad, on the prevalence and incidence of prescriptions of zolpidem according to the age. METHODS This study was based on an observational study using the French healthcare data system. Two age categories were defined: "younger" and "older" (<65 years, ≥65 years); in order to study the evolution of prevalence and incidence of zolpidem use in our two groups, two periods were defined, before and after the implementation of the measure. RESULTS The prevalence decreased in the younger population by 51% (4012 vs. 7948 consumers), while that of the older population decreased by 42% (4151 vs. 7282). This difference in our two groups, with a greater decrease in the younger people, is statistically significant compared to the older people. CONCLUSION Our study showed that regulatory framework implementation and mandatory secure prescription pad is more effective for decreasing prevalence of zolpidem prescription for younger people compared to older people.
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Affiliation(s)
- Alexandra Jobert
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Research and Innovation Department, 5 allée de l’île gloriette, CEDEX, 44093 Nantes, France
| | - Marion Istvan
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, CEDEX, 44093 Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, CEDEX, 44093 Nantes, France
- CHU Nantes, Addictology and Liaison-Psychiatry Department, CEDEX, 44093 Nantes, France
| | - Benoit Schreck
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Addictology and Liaison-Psychiatry Department, CEDEX, 44093 Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, CEDEX, 44093 Nantes, France
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Istvan M, Caillet P, Rousselet M, Guerlais M, Laforgue EJ, Gérardin M, Jolliet P, Feuillet F, Victorri-Vigneau C. Change in the regulatory framework for zolpidem: What is the impact on the landscape of the prescription of sedative medications? The French national ZORRO study. Br J Clin Pharmacol 2021; 87:3310-3319. [PMID: 33506976 DOI: 10.1111/bcp.14753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS In recent years, zolpidem has been the subject of numerous reports of misuse, abuse and dependence. In view of these risks, the French drug agency (ANSM) decreed in April 2017 the implementation of secure prescription pads. The objective of this study was to evaluate the impact of this regulatory measure on the prescription of zolpidem and other sedative medications (zopiclone, benzodiazepines and antihistamines) in long-term users of zolpidem and associated factors. METHODS We performed a historical cohort study using data from the Generalist Sample of Beneficiaries (EGB). All patients aged over 18 years old who were long-term users (at least 3 months) before the measure were enacted. We analysed the reimbursement trajectories of zolpidem, zopiclone, benzodiazepines and antihistamines (hydroxyzine and alimemazine) up to 2 years after the measure using a state sequence analysis. RESULTS Overall, 2502 patients were analysed. A four-cluster typology was identified: continuation of zolpidem (n = 1044, 42%), discontinuation of sedative medications (n = 766, 31%), change to zopiclone (n = 537, 21%) and change to hypnotic benzodiazepines (n = 155, 6%). The most frequently prescribed hypnotic benzodiazepine was lormetazepam. We identified age, sex, treatment for psychiatric or addictive disorder and volume of zolpidem use before the measure as factors associated with different reimbursement trajectories after the regulatory change. CONCLUSION The regulatory change for zolpidem prescriptions reduced exposure to zolpidem among long-term users and also had a broad impact on prescriptions of other sedative medications. Switching to other medications that also present a potential risk of abuse or dependence should be carefully monitored.
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Affiliation(s)
- Marion Istvan
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France.,INSERM U1246 SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", Nantes and Tours University, Nantes, France
| | - Pascal Caillet
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France
| | - Morgane Rousselet
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France.,INSERM U1246 SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", Nantes and Tours University, Nantes, France
| | - Marylène Guerlais
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France
| | - Edouard-Jules Laforgue
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France.,INSERM U1246 SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", Nantes and Tours University, Nantes, France
| | - Marie Gérardin
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France
| | - Pascale Jolliet
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France.,INSERM U1246 SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", Nantes and Tours University, Nantes, France
| | - Fanny Feuillet
- INSERM U1246 SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", Nantes and Tours University, Nantes, France.,Plateforme de Méthodologie et de Biostatistique, Direction de la Recherche et de l'Innovation, Centre Hospitalier Universitaire de Nantes, Nantes University Hospital, France
| | - Caroline Victorri-Vigneau
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, France.,INSERM U1246 SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", Nantes and Tours University, Nantes, France
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