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Garnier C, Schein M, Lacroix C, Jouve E, Soeiro T, Gentile G, Mestre ML, Micallef J. Patterns of Pregabalin Users from Substance Abuse Treatment Facilities: Results from the French OPPIDUM Program from 2008 to 2022. CNS Drugs 2024; 38:743-751. [PMID: 38990472 DOI: 10.1007/s40263-024-01095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION In recent years, pregabalin has received growing attention due to its abuse liability. The aim of this study was to further characterize patterns of pregabalin users from substance abuse treatment facilities and detect changes in users profile over the study period. METHODS The data source was the Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse (OPPIDUM) program, an annual, repeated, cross-sectional, nationwide, multicenter survey that collects consumption data from patients with substance use disorders. First, we described the characteristics of pregabalin users and their consumption patterns. We compared these data between 2008 and 2018 (P1) and 2019 and 2022 (P2). Second, we conducted a multiple correspondence analysis to identify profiles of users. RESULTS From 2008 to 2022, 291 pregabalin users (0.37% of all users) from 116 substance abuse treatment facilities were identified. The number of pregabalin users was lower than 15 per year in P1 (n = 89) and between 40 and 60 per year in P2 (n = 202). The number of users who reported pregabalin as the first substance leading to dependence increased significantly in P2 compared with P1 (p < 0.005). When comparing P2 with P1, there was a significant increase in precarity (p < 0.001), users in prison (p = 0.002), withdrawal symptoms (p < 0.001), dependence (p < 0.001), use of higher dose of pregabalin (p = 0.029), and acquisition by deal/street market (p < 0.001). The multiple correspondence analysis allowed for the identification of distinct profiles of pregabalin users: (i) a cluster with mainly users from P1, who presented a simple use of pregabalin, and were older (> 45 years), were involved in opioid agonist treatment (OAT), and obtained pregabalin legally; and (ii) a cluster with mainly users from P2, who presented pregabalin dependence, and were younger (< 26 years), reported pregabalin as the first substance leading to dependence, used doses higher than the market authorization, were in severe precarity, and were in prison. CONCLUSIONS These data showed that the profile of pregabalin users has changed in the last years. Pregabalin use disorders also affect users without history of addiction.
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Affiliation(s)
- Clément Garnier
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
- Département Universitaire de Médecine Générale, Faculté des Sciences Médicales et paramédicales, Marseille, France
| | - Martin Schein
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
- Département Universitaire de Médecine Générale, Faculté des Sciences Médicales et paramédicales, Marseille, France
| | - Clémence Lacroix
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - Elisabeth Jouve
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - Thomas Soeiro
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - Gaétan Gentile
- Département Universitaire de Médecine Générale, Faculté des Sciences Médicales et paramédicales, Marseille, France
| | - Maryse Lapeyre Mestre
- Service de Pharmacologie Médicale et Clinique, UFR Santé Université de Toulouse - Paul Sabatier, CEIP-Addictovigilance de Toulouse, CHU de Toulouse, CIC 1436, 31000, Toulouse, France
| | - Joëlle Micallef
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France.
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Weesie YM, van Dijk L, Bouvy ML, Hek K. Immediate release fentanyl in general practices: Mostly off-label prescribing. Eur J Gen Pract 2023; 29:2165644. [PMID: 36695153 PMCID: PMC9879195 DOI: 10.1080/13814788.2023.2165644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The immediacy of the onset of opioids may be associated with the risk of dependency and accidental overdose. Nasal and oromucosal fentanyl dosage forms are so called immediate release fentanyl (IRF). These IRFs have been approved to treat breakthrough pain in patients with cancer who are on chronic opioid treatment only. There are signals of increased off-label prescribing of IRFs in general practices. OBJECTIVES This study aims to provide insight into the frequency of IRF prescription in Dutch general practices and the extent to which IRF is prescribed off-label. METHODS Routinely collected electronic health records of general practices (GPs) participating in Nivel Primary Care Database were used. Adult patients with IRF prescriptions in 2019 were selected from whom dispensing data on 2018 and 2019 was available. Diagnoses were recorded by GPs using International Classification of Primary Care. Descriptive analyses were performed. RESULTS This study included 342 GPs with a patient population of 1,297,942 patients, 1,368 patients received at least one IRF prescription in 2019, which is equal to 1.1 patients per 1,000 registered patients. Most patients (74.9%) with an IRF prescription received an off-label prescription. A slight majority had a cancer diagnosis but nearly 65.2% did not have a maintenance therapy and 14% were opioid-naive before receiving their first IRF prescription. CONCLUSION IRFs are not prescribed frequently in Dutch general practices. However, when prescribed, a relatively large portion of patients received an off-label prescription.
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Affiliation(s)
- Yvette M. Weesie
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands,Department of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands,CONTACT Yvette M. Weesie Otterstraat 118 – 124, Utrecht, 3513 CR, The Netherlands
| | - Liset van Dijk
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands,Department of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Marcel L. Bouvy
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), Utrecht, The Netherlands
| | - Karin Hek
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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Abstract
This paper is the forty-fifth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2022 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, USA.
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Bertin C, Montigne E, Teixeira S, Ferrer F, Lauwerie L, Richard D, Authier N. Intravenous misuse of slow-release oral morphine capsules: how much morphine is injected? Harm Reduct J 2023; 20:59. [PMID: 37106464 PMCID: PMC10134660 DOI: 10.1186/s12954-023-00781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The injection of morphine from morphine sulfate capsules containing sustained-release microbeads (Skenan®) is a practice frequently described by French intravenous opioid users. They seek an injectable form of substitution for heroin. Depending on how the syringe is prepared, the morphine rates may vary. The dosage of the capsule, the temperature of the dissolving water and the type of filter used have been identified as the parameters most likely to influence the final quantity of morphine in solution before intravenous injection. The aim of our study was to determine the amounts of morphine actually injected, according to the different preparation modalities described by people who inject morphine and the harm reduction equipment made available to them. METHODS Different morphine syringes were prepared by varying the dosage of the capsule (100 or 200 mg), the temperature of the dissolving water before adding morphine, ambient (≈ 22 °C) or heat (≈ 80 °C) and four filtration devices: risk reduction Steribox® cotton, risk reduction filter "Sterifilt®", "Wheel" filter and cigarette filter. The quantification of the morphine in the syringe body was carried out by liquid phase chromatography coupled with a mass spectrometry detector. RESULTS The best extraction yields were obtained with heated water, independently of dosages (p < 0.01). Yields of 100 mg capsules varied according to the filter (p < 0.01) and the water temperature (p < 0.01), with maximum yields obtained for solutions dissolved in heated water, then filtered with the "Wheel" filter (83 mg). The yields of the 200 mg capsules varied according to the temperature of the water (p < 0.01), without difference according to the filter used (p > 0.01), and maximum yields obtained for solutions dissolved in heated water (95 mg). CONCLUSIONS No procedure for dissolving Skenan® led to the complete dissolution of the morphine it contains. Whatever the variations in preparation conditions, the extraction rates of the 200 mg morphine capsules were lower than those of 100 mg, without the risk reduction filters adversely impacting morphine extraction. Offering an injectable substitution to persons who inject morphine would make it possible to reduce the risks and damage, particularly overdoses, associated with variations in dosage due to preparation methods.
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Affiliation(s)
- Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France.
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, 63001, Clermont-Ferrand, France.
- UFR Médecine et Professions Paramédicales, Fondation Institut Analgesia, 63001, Clermont-Ferrand, France.
| | - Edouard Montigne
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Sarah Teixeira
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Florent Ferrer
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Louis Lauwerie
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Damien Richard
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, 63001, Clermont-Ferrand, France
- UFR Médecine et Professions Paramédicales, Fondation Institut Analgesia, 63001, Clermont-Ferrand, France
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Lapeyre-Mestre M. Addictovigilance in women, the hidden part of the iceberg? Therapie 2023; 78:157-164. [PMID: 36280399 DOI: 10.1016/j.therap.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 11/07/2022]
Abstract
Epidemiology of substance use disorders and their complications is driven by a male predominance, and women, even if they are more and more prevalent, are never specifically represented in studies in the field. Apart from the time of pregnancy, which in itself requires specific prevention, treatment and follow-up, the importance of the sex of women in the complications of substance abuse is neglected. To illustrate, we described some characteristics of women identified in the addictovigilance information system in France and Europe, related to drug use disorders (both for illicit substances and medications). Even if the exposure to some psychoactive substances remains more prevalent in men, women, and particularly young women, seem to be more vulnerable to the adverse effects of these substances, as observed for opioid analgesics, benzodiazepines, cannabis and even nitrous oxide. It is now imperative that the female sex/gender be taken into consideration in addictovigilance expertise and in drug safety in general, even for substances for which use is predominantly male. In addition, the adequate management of the women requires the development of specific prevention and care strategies.
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Affiliation(s)
- Maryse Lapeyre-Mestre
- Service de pharmacologie médicale et clinique, centre d'addictovigilance (CEIP-A), CHU de Toulouse-UFR santé, université de Toulouse, 31000 Toulouse, France.
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Rueter M, Baricault B, Lapeyre-Mestre M. Patterns of opioid analgesic prescribing in cancer outpatients during the last year of life in France: A pharmacoepidemiological cohort study based on the French health insurance database. Therapie 2022; 77:703-711. [PMID: 35697537 DOI: 10.1016/j.therap.2022.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/05/2022] [Accepted: 01/24/2022] [Indexed: 12/15/2022]
Abstract
Cancer pain management with adequate analgesics for cancer outpatients can be particularly challenging. This representative retrospective cohort study aimed to investigate the prevalence and timing of weak and strong opioid analgesic prescriptions in cancer outpatients during their last year of life, with a focus on factors associated to potential late strong opioid initiation. Factors associated with late strong opioid initiation were investigated through multivariate logistic regression analyses stratified by place of death. A retrospective cohort of cancer outpatients, who died between 2014 and 2016, was identified from the general sample of beneficiaries. Among N=4704 cancer patients (median age 76 years, 42.7% women), 3002 (63.8%) were prescribed and dispensed ≥1 weak or strong opioid analgesic during their last year of life; of whom, 2458 (52.3%) received ≥1 weak opioid analgesic (tramadol as single-ingredient accounting for 25.9%) and 1733 (36.8%) ≥1 strong opioid analgesic dispensation (fentanyl 21.6%). Median interval between the first prescription for any strong opioid and death was 18 weeks (interquartile range: 8-38), and for weak opioids 33 weeks (interquartile range: 20-47). Among weak opioid users, 1229 (50.0%) patients had received ≥1 weak opioid analgesic dispensation during the year n-2 before death. Among strong opioid users, 986 (56.9%) patients had received ≥1 weak opioid analgesic dispensation during the year n-2 before death and 381 (21.9%) patients ≥1 strong opioid analgesic dispensation. Patients with an outpatient death were more likely to have a late strong opioid initiation compared to patients with an inpatient death. Late strong opioid initiation (<18 weeks before death) was significantly associated with a lower number of hospitalization days and prior weak opioid exposure for patients with an inpatient death and, with older age, social, prior weak opioid exposure, and a prescription initiation by general practitioner for patients with an outpatient death. Our gained knowledge of opioid prescribing patterns in cancer patients during the last year of life might help to progress opioid analgesic treatment and to improve patient outcomes.
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Affiliation(s)
- Manuela Rueter
- Medical and Clinical Pharmacology Unit, University Hospital Centre Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; Clinical Investigation Center (CIC) 1436, University Hospital Centre Toulouse, 31059 Toulouse cedex 9, France; Equipe Pharmacologie en Population, cohorteS, biobanqueS, PEPPS, Toulouse University, 31000 Toulouse, France.
| | - Bérangère Baricault
- Medical and Clinical Pharmacology Unit, University Hospital Centre Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - Maryse Lapeyre-Mestre
- Medical and Clinical Pharmacology Unit, University Hospital Centre Toulouse, 37, allées Jules-Guesde, 31000 Toulouse, France; Clinical Investigation Center (CIC) 1436, University Hospital Centre Toulouse, 31059 Toulouse cedex 9, France; Equipe Pharmacologie en Population, cohorteS, biobanqueS, PEPPS, Toulouse University, 31000 Toulouse, France
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