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Lépine B, Debin M, Dassieu L, Gimenez L, Palmaro A, Ponté C, Swital M, Lapeyre-Mestre M, Blanchon T, Dupouy J. GPs' practices when prescribing buprenorphine in primary care: A survey among the Sentinelles network. Therapie 2024:S0040-5957(24)00044-1. [PMID: 38729825 DOI: 10.1016/j.therap.2024.04.002] [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: 09/05/2023] [Revised: 02/05/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION France is a leading country for opioid agonist treatment providing, with a predominance of buprenorphine. General practitioners (GPs) are the main prescribers of buprenorphine, but they seem to be less involved over the last 10 years. This work is the second part of a larger study analysing buprenorphine prescribing among French GPs working in primary care, and aims to describe GPs' practices when prescribing buprenorphine. METHODS This is a cross-sectional study conducted in France from March to July 2021 among a sample of GPs in the Sentinelles network, a national epidemiologic surveillance system. Data about the last situations of initiation and renewal of buprenorphine were collected. RESULTS Among the 237 participants (34.3% response rate), 156 responded to the questionnaire about the last situation of renewal and 41 about the last situation of initiation. The last initiation occurred more than 12 months earlier for 46.3% of respondents, whereas the last renewal occurred less than 1 month ago for 68.6%. There was an over-representation of the male gender among the patients who were consulting (initiation 70.7%, renewal 68.6%). A majority of patients had an illicit opioid use disorder (initiation 78.0%, renewal 82.7%). Overall, GPs were involved in the general care of patients with opioids use disorder and in opioids harm reduction (initiation 87.8% and 82.9%, renewal 88.5% and 51.9%). CONCLUSION Among buprenorphine prescribers, initiations were infrequent unlike renewals and involved mainly illicit opioid users.
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Affiliation(s)
- Barbara Lépine
- Département universitaire de médecine générale, faculté de médecine, université de Toulouse, 133, route de Narbonne, 31063 Toulouse, France
| | - Marion Debin
- Inserm, institut Pierre Louis d'épidémiologie et de santé publique, IPLESP, Sorbonne université, 75012 Paris, France
| | - Lise Dassieu
- Centre de recherche du centre hospitalier de l'université de Montréal, Montréal, QC, H2X0A9, Canada
| | - Laetitia Gimenez
- Département universitaire de médecine générale, faculté de médecine, université de Toulouse, 133, route de Narbonne, 31063 Toulouse, France; MSPU La Providence, 31500 Toulouse, France; CERPOP, Inserm, UPS, université de Toulouse, 31000 Toulouse, France
| | - Aurore Palmaro
- Département universitaire de médecine générale, faculté de médecine, université de Toulouse, 133, route de Narbonne, 31063 Toulouse, France
| | - Camille Ponté
- Service de pharmacologie medicale et clinique, CEIP-addictovigilance, CIC 1436, faculte de medecine, 31000 Toulouse, France
| | - Morgane Swital
- Inserm, institut Pierre Louis d'épidémiologie et de santé publique, IPLESP, Sorbonne université, 75012 Paris, France
| | - Maryse Lapeyre-Mestre
- Service de pharmacologie medicale et clinique, CEIP-addictovigilance, CIC 1436, faculte de medecine, 31000 Toulouse, France
| | - Thierry Blanchon
- Inserm, institut Pierre Louis d'épidémiologie et de santé publique, IPLESP, Sorbonne université, 75012 Paris, France
| | - Julie Dupouy
- Département universitaire de médecine générale, faculté de médecine, université de Toulouse, 133, route de Narbonne, 31063 Toulouse, France; CERPOP, Inserm, UPS, université de Toulouse, 31000 Toulouse, France; MSPU de Pins Justaret, 31860 Pins Justaret, France.
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Cedeño E, Cruz A, Cortés J, Melin K, Roman L, Gonzalez A, Duconge J, Santiago D. Experiences and Preferences of Opioid-Use-Disorder Patients Who Switched from Brand to Generic Buprenorphine/Naloxone Films: A Case Series. Patient Prefer Adherence 2022; 16:69-78. [PMID: 35046643 PMCID: PMC8761029 DOI: 10.2147/ppa.s336155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Differences in the suppression of withdrawal symptoms have been observed in opioid-use-disorder (OUD) patients who were switched from Suboxone (the brand name of buprenorphine/naloxone sublingual films) to either 1 of 2 generic versions. These descriptive observations evidence the need to further assess the use of these generics and its impact on the adherence to and outcomes of OUD treatments. The objective of this case series was to describe patient and provider experiences, perceptions, and preferences when said patients were abruptly switched from Suboxone to one of the generic versions manufactured by Sandoz or Alvogen. PATIENTS AND METHODS A retrospective chart review of 24 Suboxone-maintained OUD patients from a single clinic who were forced to switch to a generic was performed to collect withdrawal and craving symptoms that occurred after the switch, as well as toxicology results and changes in dose (documented by the provider). RESULTS The medical records of 9 (37.5%) of the 24 patients showed that they were suffering from withdrawal symptoms and/or cravings, had had their doses adjusted, and/or had had a positive urine toxicology screen. All 9 subjects communicated a preference for the brand formulation over that of either of the generic versions; few expressed a preference for one generic formulation over the other. None of patients were able to switch back to the brand formulation, nor were any of them able to choose the generic that worked best for them. Insomnia, muscle pain, and gooseflesh skin were the most common withdrawal symptoms reported by the patients using the generics. Better outcomes were observed in patients who received a buprenorphine dose increase (2 mg) to suppress the withdrawal symptoms experienced while using the generics. CONCLUSION Our study serves as a reference to prescribers regarding approaches (eg, a small dose adjustment) that may potentially encourage OUD treatment adherence and even improve outcomes in patients who appear to be decompensating after the brand-to-generic switch.
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Affiliation(s)
- Erica Cedeño
- Department of Pharmacy Practice, School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Ambar Cruz
- Department of Pharmacy Practice, School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Joaris Cortés
- Department of Chemistry, Rio Piedras Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Kyle Melin
- Department of Pharmacy Practice, School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | | | | | - Jorge Duconge
- Department of Pharmaceutical Sciences, School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Darlene Santiago
- Department of Pharmaceutical Sciences, School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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