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Garnier C, Schein M, Lacroix C, Jouve E, Soeiro T, Gentile G, Lapeyre Mestre M, 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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Gandolfo P, Soeiro T, Jouve É, Revol B, Daveluy A, Bertin C, Eiden C, Gibaja V, Chaouachi L, Pérault-Pochat MC, Chevallier C, Aquizérate A, Le Boisselier R, Carton L, Lapeyre-Mestre M, Frauger É, Lacroix C, Micallef J. Patterns of ketamine use among people with substance use disorder in France: Multisource analysis of the data from the French Addictovigilance Network. Fundam Clin Pharmacol 2024. [PMID: 38372190 DOI: 10.1111/fcp.12995] [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: 09/06/2023] [Revised: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Due to its psychoactive effects, ketamine has become a drug used for non-medical purpose. OBJECTIVES To assess the latest trends in ketamine use among people with substance use disorder and to characterize its clinical complications using complementary health data sources of the French Addictovigilance Network. METHODS First, we extracted all reports involving ketamine from 2012 to 2021 from the database of the OPPIDUM program (i.e., a multicentric program conducted in collaboration with hundreds of substance abuse treatment facilities that collects data on drugs used by subjects with substance use disorders). We described the reports globally and the changes from 2012 to 2021. Second, we extracted all cases involving ketamine from July 2020 to December 2022 from the French National Pharmacovigilance Database (BNPV). We identified the cases related to ketamine use among people with substance use disorder and described them. RESULTS There was a 2.5-fold increase in the number of ketamine users with substance use disorder in the OPPIDUM program, from 35 (0.7%) subjects in 2012 to 89 (1.7%) subjects in 2021. There was an increase in the proportion of subjects who were daily users, had distress upon discontinuation, and presented addiction. There were 238 cases related to ketamine use among people with substance use disorder in the French National Pharmacovigilance Database from July 2020 to December 2022. Among them, 94 (39.5%) cases involved ketamine use disorder, 20 (8.4%) cases involved urinary tract and kidney symptoms, and 13 (5.5%) cases involved hepatobiliary symptoms. CONCLUSION The trend observed over 10 years reflects the growth in ketamine use among people with substance use disorder, although it does not allow to estimate the rates of non-medical use of ketamine in the general population. Ketamine-induced uropathy and cholangiopathy are reported in ketamine users with substance use disorder, especially in case of repeated and/or prolonged use of high doses.
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Affiliation(s)
- Pauline Gandolfo
- U1106 Aix-Marseille Université, Inserm, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Thomas Soeiro
- U1106 Aix-Marseille Université, Inserm, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Élisabeth Jouve
- U1106 Aix-Marseille Université, Inserm, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Bruno Revol
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Grenoble, Grenoble, France
| | - Amélie Daveluy
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Célian Bertin
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Céline Eiden
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Montpellier, Montpellier, France
| | - Valérie Gibaja
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Nancy, Nancy, France
| | - Leila Chaouachi
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Paris, Paris, France
| | - Marie-Christine Pérault-Pochat
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Cécile Chevallier
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Lyon, Lyon, France
| | - Aurélie Aquizérate
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Nantes, Nantes, France
| | - Reynald Le Boisselier
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Caen, Caen, France
| | - Louise Carton
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Lille, Lille, France
| | - Maryse Lapeyre-Mestre
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Élisabeth Frauger
- U1106 Aix-Marseille Université, Inserm, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Clémence Lacroix
- U1106 Aix-Marseille Université, Inserm, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Joëlle Micallef
- U1106 Aix-Marseille Université, Inserm, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance, Service de pharmacologie clinique, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Diaz L, Eiden C, Jouanjus E, Frauger E, Fouilhé N, Djezzar S, Gibaja V, Boucher A, Le Boisselier R, Libert F, Caous AS, Monzon E, Guerlais M, Daveluy A, Fauconneau B, Peyrière H. Alprazolam misuse: Analysis of French Addictovigilance Network data from 2011 to 2020. Therapie 2023; 78:647-657. [PMID: 36918317 DOI: 10.1016/j.therap.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Alprazolam, a high-potency and short-acting anxiolytic benzodiazepine, is one of the most misused benzodiazepines in France. In the context of various reports on alprazolam misuse during the COVID-19 pandemic, the objective of this study was to assess alprazolam abuse potential by analyzing French addictovigilance and international data. METHODS Data collected from 2011 to 2020 using the following epidemiological tools of the French Addictovigilance Network were analyzed: spontaneous reports (SRs), OPPIDUM (addiction care center data), OSIAP (falsified prescriptions), DRAMES (substance-related deaths), and chemical submission surveys. Moreover, the VigiBase™ database was analyzed to evaluate alprazolam abuse liability worldwide. RESULTS During the study period, 675 SRs concerning alprazolam misuse were recorded (sex ratio: ̴1; median age: 39 years). The desired effects were intensification of the therapeutic anxiolytic effect, euphoric effect, and management of substance withdrawal. Alprazolam was the third and first benzodiazepine listed in OPPIDUM and OSIAP surveys. Analysis of the SR and OPPIDUM data showed a recent increase in the alprazolam-opioid combination. In DRAMES data, alprazolam was directly linked to 11 deaths (associated with opioids in 10/11). VigiBase™ data analysis highlighted that France was the third country with the most cases of alprazolam misuse. The disproportionality analysis showed that in France, alprazolam was associated with higher risk of misuse and dependence compared with other benzodiazepines: reporting odds ratio=1.43, (95% CI: 1.04-1.95) and=1.97 (95% CI:1.50-2.59), respectively. CONCLUSIONS This study highlighted an increase in various signals of alprazolam abuse in France, and an increased use of the alprazolam-opioid combination that was also linked to most of the recorded alprazolam-linked deaths. These signals have been reported also in the international literature, and should be thoroughly investigated.
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Affiliation(s)
- Laurine Diaz
- Addictovigilance Centre, Lapeyronie Hospital, CHU de Montpellier, Univ Montpellier, 34000 Montpellier, France
| | - Céline Eiden
- Addictovigilance Centre, Lapeyronie Hospital, CHU de Montpellier, Univ Montpellier, 34000 Montpellier, France
| | - Emilie Jouanjus
- Addictovigilance Centre, Medecine Faculty, CHU, 31000 Toulouse, France
| | | | | | - Samira Djezzar
- Addictovigilance Centre, Fernand Widal Hospital, 75000 Paris, France
| | | | | | | | - Frédéric Libert
- Addictovigilance Centre-CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | | | - Emilie Monzon
- Agence Nationale de Sécurité des Médicaments et Produits de Santé (ANSM), 93210 Saint Denis La Plaine, France
| | | | - Amélie Daveluy
- Addictovigilance Centre-CHU Bordeaux, 33000 Bordeaux, France
| | | | - Hélène Peyrière
- Addictovigilance Centre, Lapeyronie Hospital, CHU de Montpellier, Univ Montpellier, 34000 Montpellier, France; Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, CHU Montpellier, 34000 Montpellier, France.
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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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Blayac L, Ponte C, Lavaud M, Micallef J, Lapeyre-Mestre M. Increase of cannabis and cocaine use by pregnant women in France from 2005 to 2018: Insights of the annual cross sectional OPPIDUM survey. Therapie 2023; 78:201-211. [PMID: 36283856 DOI: 10.1016/j.therap.2022.10.003] [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: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Substance use disorders during pregnancy are associated with antenatal, neonatal and long-term adverse drug reactions in children. The aim of this study was to describe, using data from OPPIDUM survey, the evolution of illicit substance use or diverted prescription drug use among pregnant women visiting French addiction care centres from 2005 to 2018. MATERIAL AND METHOD The current study focused on women of childbearing age (15-44years old) identified as pregnant, and included in the OPPIDUM survey from 2005 to 2018. OPPIDUM is a French nationwide survey repeated each year since 1995, which anonymously collects information on drug abuse and dependence observed in patients recruited in addiction care centres. Patterns of illicit substance use, psychoactive medications, and opioid maintenance treatment (OMT) were described over time (by period of 2 years) and changes between 2005-2006 and 2017-2018 were investigated. RESULTS From 2005 to 2018, 784 pregnant women were included in the OPPIDUM survey (median age 28, interquartile range (IQR): 25-33). The proportion of women using exclusively cannabis (1.2% vs. 17.1%, P=0.0004) and cocaine (including crack) use (4.7% vs. 14.3%, P=0.0384) significantly increased over the period. Considering the first substance reported as leading to dependence, heroin significantly decreased (78.8% vs. 50.0%, P=0.0002) whereas cannabis significantly increased (5.9% vs. 25.7%, P=0.0005). CONCLUSION This study highlighted an important change of patterns of drug use by French pregnant women over a 14-year-period. Health professionals must be aware of these changes to adapt prevention and care among women of childbearing age and pregnant women.
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Affiliation(s)
- Léna Blayac
- Service de pharmacologie médicale et clinique, centre d'addictovigilance (CEIP-A), CHU de Toulouse - UFR santé, université de Toulouse, 31000 Toulouse, France.
| | - Camille Ponte
- Service de pharmacologie médicale et clinique, centre d'addictovigilance (CEIP-A), CHU de Toulouse - UFR santé, université de Toulouse, 31000 Toulouse, France
| | - Monique Lavaud
- École de sages-femmes, université de Toulouse, 31059 Toulouse, France
| | - Joëlle Micallef
- UMR 1106, Inserm, service de pharmacologie clinique, centre d'addictovigilance, AP-HM, Aix-Marseille université, 13005 Marseille, France
| | - 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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6
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Roussin A, Soeiro T, Fouque C, Jouanjus E, Frauger E, Fouilhé N, Mallaret M, Micallef J, Lapeyre-Mestre M. Increase of high-risk tramadol use and harmful consequences in France from 2013-2018: evidence from the triangulation of addictovigilance data. Br J Clin Pharmacol 2022; 88:3789-3802. [PMID: 35318713 PMCID: PMC9545570 DOI: 10.1111/bcp.15323] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 12/11/2022] Open
Abstract
Aims The aim of this paper is to assess recent developments in non‐medical tramadol use, tramadol use disorder, illegal procurement and deaths. Methods This study used repeated cross‐sectional analysis of data collected nationwide from 2013 to 2018. Analysis was conducted through multisource monitoring of the French Addictovigilance Network of: (1) validated reports of high‐risk tramadol use, (2) record systems collecting information from toxicology experts investigating analgesic‐related deaths (DTA) and deaths related to substance abuse (DRAMES), and pharmacists for forged prescriptions (OSIAP), and (3) survey of drug users, with investigation of patterns of use while visiting addiction‐specialised institutions (OPPIDUM). Results Despite a plateauing level of tramadol exposure in the French population, the proportion of tramadol reports increased 1.7‐fold (187 cases in 2018, 3.2% (95% confidence interval [CI]: 2.74–3.63%), versus 1.9% (95% CI: 1.49–2.42% in 2013). Trends were similar in OSIAP: 11.9% of forged prescriptions in 2018 (95% CI: 10.56–13.45%); 1.7‐fold increase; in OPPIDUM: 0.76% (95% CI: 0.55–1.02); 2.2‐fold increase; and DRAMES: 3.2% of drug abuse‐related deaths in 2018 (95% CI: 1.89–5.16) versus 1.7% in 2013 (95% CI: 0.65–3.84). Tramadol was the primary opioid in analgesic‐related deaths in DTA (45% in 2018). Two profiles of high‐risk tramadol users were identified: (1) patients treated for pain or with tramadol persistence when pain disappeared (mainly women; mean age 44 years), and (2) individuals with non‐medical use for psychoactive effects (mainly men; mean age 36 years). Conclusion The triangulation of the data obtained through addictovigilance monitoring evidenced a recent increase in high‐risk tramadol use. These findings have a practical impact on the limitation of the maximal duration of tramadol prescriptions.
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Affiliation(s)
- Anne Roussin
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France.,Pharmacologie en Population Cohortes et Biobanques, Centre d'Investigation Clinique 1436, Université de Toulouse, France
| | - Thomas Soeiro
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France
| | - Charlotte Fouque
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France
| | - Emilie Jouanjus
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France.,CERPOP, Université de Toulouse, INSERM, France
| | - Elisabeth Frauger
- Aix-Marseille Université, Assistance publique-Hôpitaux de Marseille, Inserm, Inst Neurosci System, UMR 1106, Service de pharmacologie clinique et Pharmacovigilance, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Marseille, France
| | - Nathalie Fouilhé
- Département de Pharmacologie Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire Grenoble Alpes, France
| | - Michel Mallaret
- Département de Pharmacologie Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire Grenoble Alpes, France
| | - Joëlle Micallef
- Aix-Marseille Université, Assistance publique-Hôpitaux de Marseille, Inserm, Inst Neurosci System, UMR 1106, Service de pharmacologie clinique et Pharmacovigilance, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Marseille, France
| | - Maryse Lapeyre-Mestre
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France.,Pharmacologie en Population Cohortes et Biobanques, Centre d'Investigation Clinique 1436, Université de Toulouse, France
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Perri-Plandé J, Miremont-Salamé G, Micallef J, Herman C, Baumevieille M, Abriat F, Lapeyre-Mestre M, Haramburu F, Daveluy A. A 13-Year National Monitoring Study to Assess Narcotic Prescriptions and Indications (2007-2019). Drug Saf 2021; 45:37-44. [PMID: 34714529 DOI: 10.1007/s40264-021-01124-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Analgesics are among the most widely used drugs worldwide. This study describes the population treated with narcotic analgesics, their therapeutic indications and how the data have evolved over a decade. METHODS A cross-sectional, national, multicentre survey study was conducted that included surveys taken every year from 2007 to 2019 in a national sample of 1500 randomly selected dispensing pharmacies. RESULTS The mean age of patients, mostly women (around 60%), remained stable over the study period (63.2 ± 17.1 years in 2007, 68.2 ± 17.2 years in 2019). The proportion of patients treated for more than 3 months increased from 2007 to 2019. Most prescriptions involved morphine, oxycodone and fentanyl (98.5% of all prescriptions in 2019). Morphine prescriptions dropped dramatically from 49.6% (2007) to 32.3% (2019) of the total narcotic analgesics. Fentanyl prescriptions varied from 40.1% in 2007 to 32.2% in 2019. Prescriptions of oxycodone, regardless of the indication, increased steadily from 2007, from 8.3 to 34% in 2019, becoming the most prescribed narcotic analgesic for the first time since the beginning of the survey. CONCLUSIONS This study demonstrates how narcotic opioids are prescribed, thanks to the active participation of health professionals, and confirms the striking increase in the prescription of oxycodone.
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Affiliation(s)
- Joelle Perri-Plandé
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Hôpital Pellegrin, CHU, 33076, Bordeaux Cedex, France
| | - Ghada Miremont-Salamé
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Hôpital Pellegrin, CHU, 33076, Bordeaux Cedex, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | - Joëlle Micallef
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Cameron Herman
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Hôpital Pellegrin, CHU, 33076, Bordeaux Cedex, France
| | - Marie Baumevieille
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Hôpital Pellegrin, CHU, 33076, Bordeaux Cedex, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | - Frédéric Abriat
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Hôpital Pellegrin, CHU, 33076, Bordeaux Cedex, France
| | | | - Françoise Haramburu
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Hôpital Pellegrin, CHU, 33076, Bordeaux Cedex, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | - Amélie Daveluy
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Hôpital Pellegrin, CHU, 33076, Bordeaux Cedex, France. .,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, UMR 1219, Bordeaux, France.
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8
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Batisse A, Eiden C, Deheul S, Monzon E, Djezzar S, Peyrière H. Chemsex practice in France: An update in Addictovigilance data. Fundam Clin Pharmacol 2021; 36:397-404. [PMID: 34494320 DOI: 10.1111/fcp.12725] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Complications related to Chemsex practice (consumption of psychoactive substances in sexual context) were first assessed by the French Addictovigilance Network in 2014. In response to the deaths reported in 2016, a new expert report was commissioned to update the complications and evolution of Chemsex-related practices in France. METHODS Between January 2008 and August 2017, all Chemsex cases collected through the French Addictovigilance Network's epidemiological tools were analyzed. Comparison of data between two periods (before and after 2014) was performed to assess the evolution of practices. RESULTS Over the entire survey period, 235 Chemsex cases were identified, all of them in men, with a mean ± SD age of 39 ± 11 years, including 24 deaths (10.2%). An increase in the number of reported cases was observed from one in 2008 to 50 in the first 8 months of 2017. The main medical histories include human immunodeficiency virus (HIV; 45%) and hepatitis C (20%) infections, and substance use disorders (36%). In those 235 cases, 345 psychoactive substances were identified, mainly cathinones. Polydrug use was reported in 75% of cases. The main complications were substance use disorders (63%), acute neurological or cardiovascular intoxications (50%), various psychiatric disorders (39%), and viral and bacterial infections (18%). γ-Butyrolactone (GBL) was present in 95% of comas. An increase in the number of deaths was observed during the survey period. CONCLUSION The French Addictovigilance Network, via this pharmacoepidemiological surveillance, warns public health authorities in order to support harm reduction programs and the management of Chemsexers.
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Affiliation(s)
- Anne Batisse
- Addictovigilance Center, Fernand-Widal Hospital Paris, Paris, France
| | - Céline Eiden
- Addictovigilance Center, Department of Medical Pharmacology and Toxicology, Lapeyronie Hospital, University Hospital of Montpellier, Montpellier, France
| | - Sylvie Deheul
- Addictovigilance Center, Department of Pharmacology, University Hospital of Lille, Lille, France
| | - Emilie Monzon
- Narcotic Department, National Medicine Agency, Saint-Denis, France
| | - Samira Djezzar
- Addictovigilance Center, Fernand-Widal Hospital Paris, Paris, France
| | - Hélène Peyrière
- Addictovigilance Center, Department of Medical Pharmacology and Toxicology, Lapeyronie Hospital, University Hospital of Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infections, Univ Montpellier, INSERM, EFS, CHU Montpellier, Montpellier, France
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9
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Misuse and dependence of dimenhydrinate: A mixed studies systematic review. J Psychiatr Res 2021; 136:581-588. [PMID: 33153760 DOI: 10.1016/j.jpsychires.2020.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dimenhydrinate (DMH) is an antihistamine used to treat nausea and vomiting. Although widely available in pharmacies as an over the counter medication, there have been reports of potential DMH tolerance and dependence and a possible euphoric potential accompanying heavy use (>100 mg/day). Despite the potential for misuse, there is a gap in the literature concerning patterns, characteristics, and potential mechanisms of DMH misuse. AIMS This review aimed to synthesize evidence on the pharmacology, clinical effects, and management of DMH misuse and dependence to inform clinical decision making and relevant drug policy. METHODS We conducted a systematic review in accordance with the PRISMA guidelines and using Cochrane collaboration methods. We searched seven databases from their inception through July 2019. To be included in the review, studies needed to measure or focus on one or more dimensions of morbidity or mortality related to the misuse of DMH. Quantitative, qualitative and mixed-method studies were included in order to capture the breadth of possible studies. Studies were excluded if they did not fit into the conceptual framework of the study of if they focused primarily on the misuse of other substances. A narrative synthesis of study findings was pursued given the limited capacity for a quantitative meta-analysis. FINDINGS We identified 24 studies, which described a range of neuropsychiatric sequelae related to DMH consumption, including seizures, psychosis, depression, intoxication (resembling anticholinergic syndrome) and withdrawal. The sedative and euphoric properties, readily available nature, and low cost of DMH appear to facilitate DMH dependence, which were more commonly reported among individuals who had concurrent psychiatric disorders, displaying symptoms such as low motivation, poor concentration, and delirium. The overall quality of studies identified by this review was low-largely because the majority of studies were case reports or review articles, with few intervention or cohort studies. CONCLUSIONS There is some evidence to suggest the existence of DMH-related syndromes involving intoxication, withdrawal, and dependence, more commonly among long-term, heavy DMH consumers. However, higher quality studies are needed to confirm preliminary findings that there may be a biological basis for such syndromes.
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Soeiro T, Pradel V, Lapeyre-Mestre M, Micallef J. Evolution of doctor shopping for oxycodone in the 67 million inhabitants in France as a proxy for potential misuse or abuse. Pain 2021; 162:770-777. [PMID: 33021567 DOI: 10.1097/j.pain.0000000000002093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/23/2020] [Indexed: 01/10/2023]
Abstract
ABSTRACT This nationwide study aimed to compare use of oxycodone and doctor shopping for oxycodone in 2010 and 2016, and to quantify doctor shopping for oxycodone by sex, age, formulation, and dosage in 2010 and 2016. This study is a cross-sectional comparative analysis of doctor shopping based on all dispensings of oxycodone in France, in 2010 and 2016. Dispensings of oxycodone were extracted from the Système national des données de santé, which covers the 67 million inhabitants in France. Quantification of doctor shopping relies on an algorithm accounting for overlapping prescriptions, which is a proxy for potential misuse or abuse. The number of subjects who received oxycodone increased by 214% from 67,838 subjects in 2010 to 212,753 subjects in 2016, and the number of subjects with doctor-shopping behavior increased by 197%, from 1066 subjects in 2010 to 3163 subjects in 2016. For 30- to 44-year-old men, the total quantity of oxycodone obtained by doctor shopping increased by 391%, from 4582 defined daily doses in 2010 to 22,517 defined daily doses in 2016. By formulation and dosage, the total quantity of oxycodone obtained by doctor shopping increased with the dosage for both immediate-release and extended-release tablets in 2010 and 2016. The widespread extent of doctor shopping and its 3-fold increase in line with population exposure is a strong signal in the French context. These results are another argument to avoid trivializing oxycodone to prevent misuse, potential abuse, and potential oxycodone-related deaths, but it requires caution to prevent compromising effective treatment of pain.
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique, Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'évaluation et d'information sur la pharmacodépendance, Addictovigilance, France
| | - Vincent Pradel
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique, Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'évaluation et d'information sur la pharmacodépendance, Addictovigilance, France
| | - Maryse Lapeyre-Mestre
- Université Paul Sabatier, Inserm, UMR 1027, Centre hospitalier universitaire de Toulouse, Service de pharmacologie clinique, Centre d'évaluation et d'information sur la pharmacodépendance, Addictovigilance, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique, Hôpitaux de Marseille, Service de pharmacologie clinique, Centre d'évaluation et d'information sur la pharmacodépendance, Addictovigilance, France
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Bargel S, Becam J, Chanu L, Lanot T, Martin M, Vaucel J, Willeman T, Fabresse N. Les gabapentinoïdes : une revue de la littérature. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Revol B, Delorme J, Jouanjus É, Spadari M, Djezzar S, Lepelley M, Khouri C, Fouilhé Sam-Laï N, Mallaret M. [Thirty years of nefopam abuse in France]. Therapie 2021; 76:527-537. [PMID: 33618914 DOI: 10.1016/j.therap.2021.01.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/17/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
AIM OF THE STUDY The use of nefopam is constantly increasing in France. The objectives of this study were to quantify the intensity of the drug dependence signal, to identify the populations at risk and the risk factors of dependence. METHODS All serious and non-serious cases of misuse, abuse, drug dependence, overdose and withdrawal syndrome reported to the French Addictovigilance Network since 1988 were reviewed. An analysis of nefopam reimbursement data from the French national EGB (échantillon généraliste des bénéficiaires) database for the period 2006-2017 was also performed. RESULTS The drug dependence profile of nefopam is close to that of a psychostimulant. Our literature review and the analysis of spontaneous reports confirm the risk of abuse and dependence of nefopam. In addition to a frequent psychiatric history (depression, psychosis, anxiety), nearly half of the patients also present addictive disorders, including more than one-third with opioid-dependence. In almost half of the 120 reported cases, the main adverse reaction was dependence and the frequency of serious effects was greater than 40%. In nearly 70% of the reported cases, the use was associated with chronic pain, which might explain the prolonged use. Moreover, the analysis of data on the reimbursement of nefopam in the general population showed that one French person out of two, having a prescription for nefopam, presented chronic pain. However, nefopam is only indicated in the treatment of acute painful conditions. Although it does not seem to be associated with a greater risk of abuse or dependence, taking the drug orally is another very frequent off-label use that needs to be regulated. CONCLUSION In France, the prescription of nefopam outside of its marketing authorization is regrettable, because it contributes to the development of abuse and drug dependence.
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Affiliation(s)
| | - Jessica Delorme
- CEIP-A Clermont-Ferrand, Inserm 1107, OFMA, 63003 Clermont-Ferrand, France
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Soeiro T, Lacroix C, Pradel V, Lapeyre-Mestre M, Micallef J. Early Detection of Prescription Drug Abuse Using Doctor Shopping Monitoring From Claims Databases: Illustration From the Experience of the French Addictovigilance Network. Front Psychiatry 2021; 12:640120. [PMID: 34079478 PMCID: PMC8165176 DOI: 10.3389/fpsyt.2021.640120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence. Awareness of prescription drug abuse has been increasing in the last two decades, and organizations such as the International Narcotics Control Board has predicted that, worldwide, prescription drug abuse may exceed the use of illicit drugs. Assessment of prescription drug abuse tackles an issue that is hidden by nature, which therefore requires a specific monitoring. The current best practice is to use multiple detection systems to assess prescription drug abuse by various populations in a timely, sensitive, and specific manner. In the early 2000's, we designed a method to detect and quantify doctor shopping for prescription drugs from the French National Health Data System, which is one of the world's largest claims database, and a first-class data source for pharmacoepidemiological studies. Doctor shopping is a well-known behavior that involves overlapping prescriptions from multiple prescribers for the same drug, to obtain higher doses than those prescribed by each prescriber on an individual basis. In addition, doctor shopping may play an important role in supplying the black market. The paper aims to review how doctor shopping monitoring can improve the early detection of prescription drug abuse within a multidimensional monitoring. The paper provides an in-depth overview of two decades of development and validation of the method as a complementary component of the multidimensional monitoring conducted by the French Addictovigilance Network. The process accounted for the relevant determinants of prescription drug abuse, such as pharmacological data (e.g., formulations and doses), chronological and geographical data (e.g., impact of measures and comparison between regions), and epidemiological and outcome data (e.g., profiles of patients and trajectories of care) for several pharmacological classes (e.g., opioids, benzodiazepines, antidepressants, and methylphenidate).
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Clémence Lacroix
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Vincent Pradel
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
| | - Maryse Lapeyre-Mestre
- Université Paul Sabatier, Inserm, CIC 1436, Centre Hospitalier Universitaire de Toulouse, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Toulouse, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, UMR 1106, Hôpitaux Universitaires de Marseille, Service de Pharmacologie Clinique, Centre d'évaluation et d'information sur la Pharmacodépendance - Addictovigilance, Marseille, France
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Zhang X, Yu H, Bai R, Ma C. Identification and Characterization of Biomarkers and Their Role in Opioid Addiction by Integrated Bioinformatics Analysis. Front Neurosci 2020; 14:608349. [PMID: 33328875 PMCID: PMC7729193 DOI: 10.3389/fnins.2020.608349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
Although numerous studies have confirmed that the mechanisms of opiate addiction include genetic and epigenetic aspects, the results of such studies are inconsistent. Here, we downloaded gene expression profiling information, GSE87823, from the Gene Expression Omnibus database. Samples from males between ages 19 and 35 were selected for analysis of differentially expressed genes (DEGs). Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and Gene Ontology (GO) enrichment analyses were used to analyze the pathways associated with the DEGs. We further constructed protein-protein interaction (PPI) networks using the STRING database and used 10 different calculation methods to validate the hub genes. Finally, we utilized the Basic Local Alignment Search Tool (BLAST) to identify the DEG with the highest sequence similarity in mouse and detected the change in expression of the hub genes in this animal model using RT-qPCR. We identified three key genes, ADCY9, PECAM1, and IL4. ADCY9 expression decreased in the nucleus accumbens of opioid-addicted mice compared with control mice, which was consistent with the change seen in humans. The importance and originality of this study are provided by two aspects. Firstly, we used a variety of calculation methods to obtain hub genes; secondly, we exploited homology analysis to solve the difficult challenge that addiction-related experiments cannot be carried out in patients or healthy individuals. In short, this study not only explores potential biomarkers and therapeutic targets of opioid addiction but also provides new ideas for subsequent research on opioid addiction.
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Affiliation(s)
- Xiuning Zhang
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang, China.,Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China.,Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hailei Yu
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang, China.,Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
| | - Rui Bai
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang, China.,Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
| | - Chunling Ma
- Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, College of Forensic Medicine, Hebei Medical University, Shijiazhuang, China.,Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
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Lalanne S, Caradec Q, Baert A, Bouvet R, Morel I, Polard E, Gicquel T. Réunions pluridisciplinaires déterminant l’imputabilité des xénobiotiques dans les causes de la mort : quel apport aux données de pharmacovigilance ? Therapie 2020; 75:481-490. [DOI: 10.1016/j.therap.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/06/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
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16
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Eiden C, Vincent M, Serrand C, Serre A, Richard N, Picot MC, Frauger E, Fouilhé N, Daveluy A, Peyrière H. Health consequences of cocaine use in France: data from the French Addictovigilance Network. Fundam Clin Pharmacol 2020; 35:455-465. [PMID: 32854152 DOI: 10.1111/fcp.12603] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Abstract
As the number and severity of complications related to cocaine use reported to the French Addictovigilance Network have increased, the French health authorities requested a national epidemiologic study of the data collected by this network from 2010 to 2016. For this purpose, the spontaneous reports (SRs) linked to cocaine notified by health professionals were analyzed as well as the data from the pharmacoepidemiological surveys OPPIDUM (observation of illegal drugs and misuse of psychotropic medications) and DRAMES (deaths related to the abuse of licit and illicit psychoactive substances). In total, 1 265 SRs were analyzed (510% increase from 2010 to 2016). Users were mainly men (952/1 261; 75%), with a median age of 35.0 years [IQ25-75 : 28-42]. Cocaine was consumed through the intranasal route by 52% of users (416/797), followed by intravenous administration (32%, 253/797) and inhalation (24%, 190/797). The use of cocaine powder and crack cocaine was reported in 70% (475/674) and 23% (154/674) of SRs, respectively. Cocaine was consumed with other psychoactive substances and alcohol in 47% (603/1265) and 60% (387/649) of cases, respectively. The main cocaine-related complications were psychiatric complications (29%), neurologic complications (24%) and cardiovascular complications (23%). Analysis of the OPPIDUM survey data showed that in 2016, 15.9 and 2.4% of the included subjects consumed cocaine or crack cocaine the week preceding the survey, the highest rate for the 2006-2016 period. The DRAMES survey indicated that cocaine-related deaths increased by threefold from 2014 to 2016. These data confirm that cocaine use in France is worrying with an increase in the number of severe complications and deaths.
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Affiliation(s)
- Céline Eiden
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Marc Vincent
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Chris Serrand
- Unité de Recherche Clinique et d'Epidémiologie, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Anais Serre
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Nathalie Richard
- ANSM Agence Nationale de Sécurité du Médicament et des Produits de Santé, Saint-Denis, 93285, France
| | - Marie-Christine Picot
- Unité de Recherche Clinique et d'Epidémiologie, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Elisabeth Frauger
- Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodependance Paca Corse, Hôpital de la Timone, Marseille, 13005, France
| | - Nathalie Fouilhé
- Centre d'Addictovigilance, CHU de Grenoble, Grenoble cedex 9, 38043, France
| | - Amélie Daveluy
- Centre d'Addictovigilance, Service de Pharmacologie Médicale, CHU de Bordeaux, INSERM U657, Place Amélie Raba-Léon, Bordeaux, 33000, France
| | - Hélène Peyrière
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
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Debruyne D, Monzon E, Perino J, Haramburu F, Daveluy A, Lazès-Charmetant A, Giraudon I. [Use of synthetic substances in France and in Europe]. Therapie 2020; 76:221-228. [PMID: 32859404 DOI: 10.1016/j.therap.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Abstract
This paper aims to present the main information presented at the 9th Meeting about addictovigilance in 2016 by four healthcare professionals and addiction experts on the issue of new psychoactive substance use. A new psychoactive substance (NPS) is defined as a narcotic or psychotropic drug, in pure form or in preparation, that is not controlled by the United Nations drug conventions, but which may pose a public health threat comparable to that posed by substances listed in these conventions. The emergence of NPS consumption is a worldwide concern. Although NPS are less consumed than established drugs, there has been a sharp increase in their use over the last few years, notably of synthetic cathinones, synthetic cannabinoids and, more recently, synthetic opioids. The latter in particular are involved in deaths in Europe. However, "established" drugs (MDMA [methylenedioxymethamphetamine], amphetamines, LSD, methamphetamine) are far from being dethroned by the more recent substances: they are considered "a safe bet" already "tried and tested" by many consumers over the years. MDMA, in particular, also known as ecstasy, which has been used as a recreational drug since the 1990s, saw its consumption decrease until 2010, and then increase again, especially in higher amounts; inexpensive and easily accessible, it is increasingly associated with emergency admissions or deaths in France. The perpetual appearance of new substances on the drug market is obligating to improve knowledge on these products, particularly by focusing on their analytical identification, and also by monitoring their use and harms.
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Affiliation(s)
- Danièle Debruyne
- Centre d'addictovigilance, service de pharmacologie, CHU de Caen, 14033 Caen, France
| | - Emilie Monzon
- Pôle stupéfiants, psychotropes et médicaments des addictions aux stupéfiants, Agence Nationale de sécurité du médicament et des produits de santé, 93200 Saint-Denis, France
| | - Justine Perino
- Centre d'addictovigilance, service de pharmacologie médicale, CHU de Bordeaux, 33000 Bordeaux, France
| | - Françoise Haramburu
- Centre d'addictovigilance, service de pharmacologie médicale, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux, INSERM, BPH, U1219, 33000 Bordeaux, France; ADERA, 33600 Pessac, France
| | - Amélie Daveluy
- Centre d'addictovigilance, service de pharmacologie médicale, CHU de Bordeaux, 33000 Bordeaux, France; Université Bordeaux, INSERM, BPH, U1219, 33000 Bordeaux, France; ADERA, 33600 Pessac, France.
| | | | - Isabelle Giraudon
- European Monitoring Centre for Drugs amd Drug Addiction (EMCDDA), 1750-147, Lisbonne, Portugal
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18
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Daveluy A, Micallef J, Sanchez-Pena P, Miremont-Salamé G, Lassalle R, Lacueille C, Grelaud A, Corand V, Victorri-Vigneau C, Batisse A, Le Boisselier R, Peyrière H, Frauger E, Lapeyre-Mestre M, Haramburu F. Ten-year trend of opioid and nonopioid analgesic use in the French adult population. Br J Clin Pharmacol 2020; 87:555-564. [PMID: 32496599 DOI: 10.1111/bcp.14415] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Analgesics are the most widely used medicines worldwide. In parallel, opioid abuse has increased and is of major concern. The accessibility of pharmacologically powerful medicines and the addictovigilance signals in France about the risk of opiates addiction call for an overview of analgesic use. The objective of this study was to investigate the use of analgesics reimbursed in France over a 10-year period through its prevalence. METHODS A cross-sectional study repeated yearly was conducted by using data from the French reimbursement database from 2006 to 2015. Analgesics were classified according to their pharmacological potency: prevalence of use for each category and sociodemographic characteristics of patients treated were analysed. RESULTS The annual prevalence of analgesic use was high and increased during the study period (59.8%, 253 976 users in 2015). In 2015, prevalence was always higher in women and increased with age, except for those older than 84 years. Peripheral analgesics were the most used (55.3%, 234 739 users). The prevalence of weak analgesic use decreased (21.3%, 90 257 users), mainly due to the definitive withdrawal of dextropropoxyphene in France in 2011, which was not offset by an increase in the consumption of other weak analgesics. For strong analgesics (1.2%, 5129 users), morphine was the most widely used, with a dramatic increase in oxycodone use, especially in the elderly. CONCLUSION The prevalence of analgesic use is high: approximately 31 million adults had at least 1 analgesic reimbursed in 2015. The most widely used analgesics were peripheral analgesics, far ahead of opioid analgesics.
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Affiliation(s)
- Amélie Daveluy
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, Bordeaux, France
| | - Joëlle Micallef
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Paola Sanchez-Pena
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France
| | - Ghada Miremont-Salamé
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | | | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Virginie Corand
- Centre d'Etude et de Traitement de la Douleur, CHU Bordeaux, Bordeaux, France
| | | | - Anne Batisse
- Centre d'addictovigilance de Paris, AP-HP, France
| | | | - Hélène Peyrière
- Centre d'addictovigilance de Montpellier, CHU, Montpellier, France
| | - Elisabeth Frauger
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | | | - Françoise Haramburu
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, Bordeaux, France
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19
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Lapeyre-Mestre M, Boucher A, Daveluy A, Gibaja V, Jouanjus E, Mallaret M, Peyrière H, Micallef J. Addictovigilance contribution during COVID-19 epidemic and lockdown in France. Therapie 2020; 75:343-354. [PMID: 32660776 PMCID: PMC7309935 DOI: 10.1016/j.therap.2020.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 01/16/2023]
Abstract
Addictovigilance is a safety monitoring targeted at substances with potential for abuse and dependence. This vigilance was involved during the period of COVID-19 epidemic due to the significant changes in access to drugs and psychological disruption caused by the pandemic and lockdown. This article aims to present the different steps implemented by the French Addictovigilance network in collaboration with the French Health authorities from March to May 2020, including monitoring of potential harmful events, and scientific communication. The first events were identified through the continuity of the networking between the French addictovigilance centres and their partners: community pharmacies, general practitioners, specialized structures and emergency wards. As soon as the lockdown began, first cases of overdoses (lethal or not) were reported with opioids, mainly with methadone, and other opioids (heroin, oxycodone, tramadol or antitussive codeine). Lockdown-related noteworthy events consisted in clinical cases or other relevant information for which lockdown clearly played an important role: among the many substances identified at least once, pregabalin, benzodiazepines, cannabis, cocaine and nitrous oxide were the most significant in terms of prevalence, seriousness or particularly specific to the lockdown context. Despite significant decrease in the activity and travel limited to vital needs, community pharmacies continued to identify falsified prescriptions in this period, highlighting an increase in suspicious requests for pregabalin, codeine and tramadol. In parallel, the French addictovigilance network continued its communications efforts in the period, issuing a newsletter on tramadol, a press release on methadone and naloxone, and participating in the COVID-19 frequently asked questions (FAQs) of the French Society of Pharmacology and Therapeutic website (https://sfpt-fr.org/covid19). COVID-19 epidemic has been an important challenge for addictovigilance, and has proved that this monitoring is highly essential for alerting health professionals and health authorities to points of vigilance in the field of psychoactive substances.
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20
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Jones NS, Comparin JH. Interpol review of controlled substances 2016-2019. Forensic Sci Int Synerg 2020; 2:608-669. [PMID: 33385148 PMCID: PMC7770462 DOI: 10.1016/j.fsisyn.2020.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022]
Abstract
This review paper covers the forensic-relevant literature in controlled substances from 2016 to 2019 as a part of the 19th Interpol International Forensic Science Managers Symposium. The review papers are also available at the Interpol website at: https://www.interpol.int/content/download/14458/file/Interpol%20Review%20Papers%202019.pdf.
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Affiliation(s)
- Nicole S. Jones
- RTI International, Applied Justice Research Division, Center for Forensic Sciences, 3040 E. Cornwallis Road, Research Triangle Park, NC, 22709-2194, USA
| | - Jeffrey H. Comparin
- United States Drug Enforcement Administration, Special Testing and Research Laboratory, USA
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21
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Roy S, Eiden C, Rasanjison I, Pinzani V, Peyrière H. Medication errors involving opioid maintenance therapy. Therapie 2020; 75:295-297. [DOI: 10.1016/j.therap.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/05/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
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22
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Lancia M, Gambelunghe A, Gili A, Bacci M, Aroni K, Gambelunghe C. Pregabalin Abuse in Combination With Other Drugs: Monitoring Among Methadone Patients. Front Psychiatry 2020; 10:1022. [PMID: 32116826 PMCID: PMC7026508 DOI: 10.3389/fpsyt.2019.01022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/24/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In recent years, there has been an increase in the non-medical use of psychoactive prescription drugs including pregabalin (PGB). Studies have shown that multiple drug users and patients in methadone treatment programs administered PGB at high dosages in order to achieve euphoria, reduce withdrawal symptoms, or potentiate the effects of methadone. For these reasons, accurate toxicological monitoring is required for these high-risk individuals. MATERIALS AND METHODS The present study investigated whether PGB could be detected in the hair samples of 250 patients with a history of opiate dependency, and under toxicological surveillance assess their compliance with methadone maintenance therapy. RESULTS Opiates were found in 54/250 of all hair samples, while cannabis was present in 74/250 patients, cocaine was detected in 21/250 patients, and benzodiazepines without prescription were identified in 49/250 patients. As expected, methadone was present in all 250 patients (100%). PGB without prescription was found in the hair samples of 35/250 patients (14%). Of these, 91.43% were male, 48.57% were <30 y old, and 45.71% were between ages 30 and 50 y. There were no apparent associations among PGB use, daily methadone dosage, and duration of methadone maintenance therapy. Psychiatric comorbidities were present in 25.71% of the patients abusing PGB. Anxiety (55.56%) and depression (33.33%) were the most prevalent psychiatric disorders. DISCUSSION Most of the patients taking PGB (57.14%) used other drugs (especially opiates) concurrently. The utility of hair analysis is explained by easy and rapid sample collection and the ability of the hair to reflect long-term drug use and incorporate drug metabolites. The findings of this study suggested that PGB has significant potential for abuse by high-risk populations such as opioid users and patients with dual diagnosis. These risks are particularly high in cases of poly-drug use and drug intake that are not in compliance with prescription guidelines.
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Affiliation(s)
- Massimo Lancia
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Angela Gambelunghe
- Occupational Medicine, Respiratory Diseases and Toxicology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessio Gili
- Hygiene and Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Mauro Bacci
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Kyriaki Aroni
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Cristiana Gambelunghe
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
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23
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Vento AE, Kotzalidis GD, Cacciotti M, Papanti GD, Orsolini L, Rapinesi C, Savoja V, Calabrò G, Del Casale A, Piacentino D, Caloro M, Girardi P, Schifano F. Quetiapine Abuse Fourteen Years Later: Where Are We Now? A Systematic Review. Subst Use Misuse 2020; 55:304-313. [PMID: 31573374 DOI: 10.1080/10826084.2019.1668013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Quetiapine, an atypical antipsychotic endowed with weak dopamine antagonist, potent 5-HT2A-blocking, partial 5-HT1A-agonist, anti-H1 histamine, adrenolytic, and sigma1 receptor agonist activities, since an original 2004 report is increasingly misused. Although some of its pharmacodynamics might explain some motives for voluptuary use, most of its actions are directed at setting-off those motives. Hence, it is possible that its popularity in special populations is due to the fact that the unpleasant or unwanted effects of addiction substances are somehow soothed by quetiapine. Currently, quetiapine is tested in substance use disorders, showing some promise, but it is likely to be misused in certain contexts. Objectives: To review the evidence for the use of quetiapine as addiction substance and investigate the characteristics of populations involved in such addiction. Methods: A systematic review of literature on various databases retrieved on September 7, 2018 87 records to comment. Results. We reviewed the evidence for quetiapine's addictive potential in the light of its pharmacodynamics properties and presented two cases of recreational quetiapine use, by a 35-year old male patient with past addictive behavior and by a 50-year-old woman with major depressive disorder and conversion disorder. We found quetiapine to be abused mainly by addict populations and people with law involvement. Conclusions/Importance: There is no reason to include quetiapine among regulated substances, but monitoring of its use in selected populations is warranted. Psychiatrists and physicians working in the penitentiary system should be aware of the addictive potential of quetiapine and adopt measures restricting its use.
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Affiliation(s)
- Alessandro E Vento
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.,School of psychology - G. Marconi, Telematic University, Rome, Italy.,Addictions Observatory (ODDPSS), Rome, Italy.,Mental Health Department - ASL Roma 2, Rome, Italy
| | - Georgios D Kotzalidis
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Marta Cacciotti
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.,School of psychology - G. Marconi, Telematic University, Rome, Italy.,Addictions Observatory (ODDPSS), Rome, Italy.,Mental Health Department - ASL Roma 2, Rome, Italy
| | - G Duccio Papanti
- Udine Mental Health Department - SOPDC, Udine, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Herts, England
| | - Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Herts, England.,Neomesia Mental Health, Villa Jolanda Hospital, Jesi, Italy.,Polyedra Research, Teramo, Italy
| | - Chiara Rapinesi
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Valeria Savoja
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.,Mental Health Department, ASL Roma 4, Rome, Italy
| | - Giuseppa Calabrò
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Antonio Del Casale
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Daria Piacentino
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.,Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology (Cpn), Niaaa Dicbr and Nida Irp; National Institutes of Health, Bethesda, MD, USA
| | - Matteo Caloro
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Paolo Girardi
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Herts, England
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24
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Pacheco-Paez T, Montastruc F, Rousseau V, Chebane L, Lapeyre-Mestre M, Renoux C, Montastruc JL. Parkinsonism associated with gabapentinoid drugs: A pharmacoepidemiologic study. Mov Disord 2019; 35:176-180. [PMID: 31633228 DOI: 10.1002/mds.27876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Use of gabapentinoids is increasing. Following recent case reports, we investigated a putative risk of parkinsonism with pregabalin or gabapentin. METHODS A disproportionality analysis of 5,653,547 individual case safety reports in the World Health Organization individual case safety report database, VigiBase, compared all patients with parkinsonism who were receiving gabapentinoids with other patients. Results are shown as reporting odds ratios and the information component, an indicator of disproportionate Bayesian reporting. Sensitivity analyses included comparisons with drugs used for similar indications (amitriptyline, duloxetine) and exclusion of drugs that induce parkinsonism. RESULTS Among 5,653,547 reports, 4925 parkinsonism reports were found with pregabalin and 4881 with gabapentin. Gabapentin and pregabalin were associated with increased reporting odds ratio (2.16 [2.10-2.23], 2.43 [2.36-2.50]). Similar trends were found using information components after excluding drugs that induce parkinsonism and for pregabalin compared with amitriptyline or duloxetine. CONCLUSIONS This study found that gabapentinoids (particularly pregabalin) can be associated with parkinsonism. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tatiana Pacheco-Paez
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France.,Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Universidad de La Sabana, Chía, Colombia
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France.,INSERM, UMR 1027 Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, CIC 1426 - University Paul Sabatier Toulouse, Toulouse, France
| | - Vanessa Rousseau
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France.,INSERM, UMR 1027 Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, CIC 1426 - University Paul Sabatier Toulouse, Toulouse, France
| | - Leila Chebane
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France.,INSERM, UMR 1027 Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, CIC 1426 - University Paul Sabatier Toulouse, Toulouse, France
| | - Christel Renoux
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada
| | - Jean-Louis Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital, Faculty of Medicine, Toulouse, France.,INSERM, UMR 1027 Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, CIC 1426 - University Paul Sabatier Toulouse, Toulouse, France
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25
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Micallef J, Jouanjus É, Mallaret M, Lapeyre Mestre M. [Safety signal detection by the French Addictovigilance Network: Innovative methods of investigation, examples and usefulness for public health]. Therapie 2019; 74:579-590. [PMID: 31694770 DOI: 10.1016/j.therap.2019.09.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
Abstract
The French Addictovigilance Network aims to monitor all psychoactive substances with abuse potential including prescription drugs and other legal and illegal substances such as new psychoactive substances (NPS) and its consequences in humans. Created in 1990 through a network of regional addictovigilance centres covering the entire country, these pharmacologists with expertise in addictovigilance have developed interface with different partners (physicians, toxicologists, network of community pharmacies, addictology care centers…) and implemented several original tools of pharmacosurveillance (such as DRAMES [death related to the abuse of medicines] in strong collaboration with toxicologists or such OPPIDUM [observation of illegal products and misuse of psychotropic medications]), complementary to the spontaneous reporting. A such multidimensional approach including proactive surveillance by these tools and also among several heterogenous data sources (such as data from hospitals or claims database) is able to detect early addictovigilance signals and warnings as illustrated with three following examples: cannabis use and acute serious cardiovascular disorders, new synthetic opioids (ocfentanil, carfentanil) and severe opiate overdose or deaths, the diverted use of psychoactive drugs (codeine analgesics or sedative H1 antihistamines called purple drank) by adolescents and young adults. The choice of a broad strategy and the multifaceted system implemented by the French Addictovigilance Network using elements of pharmacology (fundamental, clinical, pharmacoepidemiology) expertise is an innovative method to detect early addictovigilance signals, and to describe its characteristics in order to increase awareness of psychoactive substances by patients, users and health professionals.
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Affiliation(s)
- Joëlle Micallef
- UMR 1106, Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Marseille, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, Aix-Marseille université, 13005 Marseille, France.
| | - Émilie Jouanjus
- UMR 1027 Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Toulouse, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, université Paul-Sabatier, 31000 Toulouse, France
| | - Michel Mallaret
- Centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, centre hospitalo-universitaire de Grenoble, 38043 Grenoble, France
| | - Maryse Lapeyre Mestre
- UMR 1027 Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Toulouse, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, université Paul-Sabatier, 31000 Toulouse, France
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26
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Schifano F, Chiappini S, Corkery JM, Guirguis A. Assessing the 2004-2018 Fentanyl Misusing Issues Reported to an International Range of Adverse Reporting Systems. Front Pharmacol 2019; 10:46. [PMID: 30774595 PMCID: PMC6367955 DOI: 10.3389/fphar.2019.00046] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/14/2019] [Indexed: 01/15/2023] Open
Abstract
Objective: A recent, global, increase in the use of opioids including the prescribing, highly potent, fentanyl has been recorded. Due its current popularity and the potential lethal consequences of its intake, we aimed here at analyzing the fentanyl misuse, abuse, dependence and withdrawal-related adverse drug reactions (ADRs) identified within the European Medicines Agency (EMA), the United Kingdom Yellow Card Scheme (YCS), and the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) databases. Methods: Descriptive analysis of both ADRs and related cases. Results: The analysis of fentanyl-related misuse, abuse, dependence and withdrawal cases reported during years 2004-2018 to the EMA, the YCS, and the FAERS showed increasing levels overtime, specifically, EMA-related data presented two peaks (e.g., in 2008 and 2015), whilst the FAERS dataset was characterized by a dramatic increase of the ADRs collected over the last 18 months, and particularly from 2016. Some 127,313 ADRs (referring to n = 6,161 patients/single cases) related to fentanyl's misuse/abuse/dependence/withdrawal issues were reported to EMA, with 14,287 being judged by the reporter as "suspect." The most represented ADRs were: "drug dependence "(76.87%), "intentional product misuse" (13.06%), and "drug abuse" (7.45%). Most cases involved adult males and the concomitant use of other prescribing/illicit drugs. A range of idiosyncratic (i.e., ingestion/injection of transdermal patches' fentanyl) and very high-dosage intake cases were here identified. Significant numbers of cases required either a prolonged hospitalization (192/559 = 34.35%) or resulted in death (185/559 = 33.09%). Within the same time frame, YCS collected some 3,566 misuse/abuse/dependence/withdrawal ADRs, corresponding to 1,165 single patients/cases, with those most frequently reported being "withdrawal," "intentional product misuse," and "overdose" ADRs. Finally, FAERS identified a total of 19,145 misuse/abuse/dependence/withdrawal-related cases, being "overdose," withdrawal, and "drug use disorder/drug abuse/drug diversion" the most represented ADRs (respectively, 43.11, 20.80, and 20.29%). Conclusion: Fentanyl abuse may be considered a public health issue with significant implications for clinical practice. Spontaneous pharmacovigilance reporting systems should be considered for mapping new trends of drug abuse.
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Affiliation(s)
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Barberot P, Gibaja V, Benkhedda C, Dobre D, Tournebize J, Kahn JP. [Identification of abuse/dependence cases by the French addictovigilance network (FAN): A pilot study of the addictovigilance center and the psychotherapeutic center of Nancy (France)]. Therapie 2018; 74:389-397. [PMID: 30392700 DOI: 10.1016/j.therap.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/27/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES France is the only European country with a dedicated addictovigilance network (French addictovigilance network [FAN]). However, the reporting of cases of abuse/dependence is insufficient. In an attempt to overcome this under-reporting, data from the medical information systems program (PMSI) is regularly used to identify cases. Since addictions are frequently associated with psychiatric comorbidities, a pilot study was conducted for the first time in a psychiatric hospital. It aims, through a PMSI request, to identify the sociodemographic characteristics and psychiatric diagnoses of patients consuming psychoactive substances (PAS) and the PAS types consumed. METHODS This is a retrospective observational study conducted over a nine-month period at the psychotherapeutic center of Nancy (CPN). The codes used for the PMSI request are those of the international classification of diseases, tenth revision (ICD-10), codes F10 to F19 that characterize mental and behavioral disorders associated with the use of PAS. Cases presenting the four criteria necessary for an addictovigilance notification: (1) identified notifier, (2) identified patient, (3) known consumed product (s) and (4) presence of an effect related to the abuse/dependence of PAS; were retained and analyzed. RESULTS On an initial number of 252 cases, 82 cases of abuse/dependence were retained. The selected sample is predominantly male (67%). Cannabis (29%) and heroin (15%) are the most common illicit PAS. Regarding drugs, the consumption of benzodiazepines, a predominantly female phenomenon, is observed in 34% of subjects. Sixty-four per cent of the subjects were diagnosed "disorders related to the use of PAS", 14% as neurotic disorders, 9% as schizophrenia and 5% as of the mood disorders. CONCLUSION This study identified a significant number of potentially reportable cases to the French Addictovigilance Network and demonstrated the interest of investigating cases of abuse/dependence in a psychiatric hospital.
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Affiliation(s)
- Pauline Barberot
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
| | - Valérie Gibaja
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; French Addictovigilance Network (FAN), 54035 Nancy, France
| | - Célia Benkhedda
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Daniela Dobre
- Département de l'information médicale et unité de recherche et d'investigation clinique, Centre psychothérapique de Nancy, 54520 Laxou, France
| | - Juliana Tournebize
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; French Addictovigilance Network (FAN), 54035 Nancy, France
| | - Jean-Pierre Kahn
- Centre d'évaluation et d'information sur la pharmacodépendance et addictovigilance (CEIP-A), CHRU de Nancy, hôpital central, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; French Addictovigilance Network (FAN), 54035 Nancy, France; Unité 6, Centre psychothérapique de Nancy, pôle de psychiatrie et psychologie clinique, 54520 Laxou, France; Université de Lorraine, 54035 Nancy, France
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Frauger E, Fouilhé Sam-Laï N, Mallaret M, Micallef J. [Improve the benefit/risk balance of methadone by respecting its pharmacological specificities]. Therapie 2018; 74:383-388. [PMID: 31178032 DOI: 10.1016/j.therap.2018.09.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/04/2018] [Accepted: 09/18/2018] [Indexed: 01/04/2023]
Abstract
Recent data on methadone from 2008 to 2017 by the French addictovigilance network warms on the increase of methadone use, its diversion, its increase of overdose risk factors (opioids associated, occasional use) and deaths. Whereas methadone is an essential drug for opioid addiction, its use remains complex because of its pharmacology leading to increase the awareness of health professionals.
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Affiliation(s)
- Elisabeth Frauger
- Inserm, service de pharmacologie clinique et pharmacovigilance, centre d'addictovigilance PACA-Corse, institut de neurosciences des systèmes, Aix-Marseille université, AP-HM, 13005, Marseille, France.
| | | | - Michel Mallaret
- Centre d'addictovigilance, CHU de Grenoble-Alpes, 38043 Grenoble, France
| | - Joëlle Micallef
- Inserm, service de pharmacologie clinique et pharmacovigilance, centre d'addictovigilance PACA-Corse, institut de neurosciences des systèmes, Aix-Marseille université, AP-HM, 13005, Marseille, France
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Daly C, Griffin E, Ashcroft DM, Webb RT, Perry IJ, Arensman E. Intentional Drug Overdose Involving Pregabalin and Gabapentin: Findings from the National Self-Harm Registry Ireland, 2007-2015. Clin Drug Investig 2018; 38:373-380. [PMID: 29264838 DOI: 10.1007/s40261-017-0616-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Intentional drug overdose (IDO) is a significant public health problem. Concerns about the misuse of gabapentinoids, i.e. pregabalin and gabapentin, including their consumption in IDO have grown in recent years. This paper examines the trends in the prevalence of gabapentinoids taken in IDO, the profile of individuals taking them, and associated overdose characteristics. METHODS Presentations to emergency departments involving IDO, recorded by the National Self-Harm Registry Ireland between 1 January 2007 and 31 December 2015 were examined. Data items included patient demographics, drug names, total tablet quantity consumed and alcohol involvement. RESULTS Gabapentinoids were involved in 2115 (2.9%) of the 72,391 IDOs recorded. Presentations involving a gabapentinoid increased proportionally from 0.5% in 2007 to 5.5% in 2015. The majority of IDOs involving a gabapentinoid were made by females (59.9%), with over one-third (37.2%) involving alcohol. Compared with IDOs involving other drugs, presentations with a gabapentinoid were made by persons who were older (median 37 vs. 32 years) and involved a significantly greater median quantity of tablets (30 vs. 21, p ≤ 0.001), with over one-quarter (27.4%) of these involving the ingestion of 50 tablets or more. Admission to hospital was significantly more common following IDOs with a gabapentinoid compared with those without (49.4% vs. 41.4%, p ≤ 0.001). CONCLUSIONS This study identified the increasing use of gabapentinoids in IDO, describing the profile and overdose characteristics of presentations. It is important for clinicians to exercise vigilance while prescribing gabapentinoids, including being aware of other medications that their patients may have access to. Our findings support the need for routine monitoring for signs of misuse among those prescribed gabapentinoids.
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Affiliation(s)
- Caroline Daly
- National Suicide Research Foundation, University College Cork, Room 4.28, Fourth Floor, Western Gateway Building, Western Road, Cork, Ireland.
| | - Eve Griffin
- National Suicide Research Foundation, University College Cork, Room 4.28, Fourth Floor, Western Gateway Building, Western Road, Cork, Ireland
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Roger T Webb
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Ivan J Perry
- National Suicide Research Foundation, University College Cork, Room 4.28, Fourth Floor, Western Gateway Building, Western Road, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, University College Cork, Room 4.28, Fourth Floor, Western Gateway Building, Western Road, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
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Frauger E, Kheloufi F, Boucherie Q, Monzon E, Jupin L, Richard N, Mallaret M, Micallef J. [Interest of take-home naloxone for opioid overdose]. Therapie 2018; 73:511-520. [PMID: 30049569 DOI: 10.1016/j.therap.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/28/2018] [Accepted: 07/02/2018] [Indexed: 12/27/2022]
Abstract
Over the course of these last decades, we observed a change on opioid use with the marketing of opiate maintenance treatment, an increase of opioids used for pain management and recent concerns have arisen around the use of synthetic opioid. The World Health Organization (WHO) reports around 70,000 people opioid overdose death each year. In France, according to the DRAMES program (fatalities in relation with abuse of licit or illicit drugs) of the French addictovigilance network, most of deaths are related to opioids overdose (especially methadone, following by heroin, buprenorphine and opioid used for pain management). Opioid overdose is treatable with naloxone, an opioid antagonist which rapidly reverses the effects of opioids. In recent years, a number of programs around the world have shown that it is feasible to provide naloxone to people likely to witness an opioid overdose. In 2014, the WHO published recommendations for this provision and the need to train users and their entourage in the management of opioid overdose. In this context, in July 2016, French drug agency has granted a temporary authorization for use of a naloxone nasal spray Nalscue®. Because different opioids can be used and because each opioid has specific characteristics (pharmacodynamics, pharmacokinetics, galenic form…), the risk of overdose may differ from one opioid to another and it may be necessary, depending on the clinical context, to use larger and repeated doses of naloxone.
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Affiliation(s)
- Elisabeth Frauger
- CEIP-addictovigilance, service de pharmacologie clinique et pharmacovigilance, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France; Aix-Marseille université, institut de neurosciences des systèmes, Inserm UMR1106, 13005 Marseille, France.
| | - Farid Kheloufi
- Aix-Marseille université, institut de neurosciences des systèmes, Inserm UMR1106, 13005 Marseille, France; Centre régional de pharmacovigilance, service de pharmacologie clinique et pharmacovigilance, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 13009 Marseille, France
| | - Quentin Boucherie
- CEIP-addictovigilance, service de pharmacologie clinique et pharmacovigilance, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France; Aix-Marseille université, institut de neurosciences des systèmes, Inserm UMR1106, 13005 Marseille, France
| | - Emilie Monzon
- ANSM, direction des médicaments en neurologie, psychiatrie, anesthésie, antalgie, ophtalmologie, stupéfiants, psychotropes et médicaments des addictions, 93285 Saint-Denis, France
| | - Leonard Jupin
- CEIP-addictovigilance, service de pharmacologie clinique et pharmacovigilance, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Nathalie Richard
- ANSM, direction des médicaments en neurologie, psychiatrie, anesthésie, antalgie, ophtalmologie, stupéfiants, psychotropes et médicaments des addictions, 93285 Saint-Denis, France
| | - Michel Mallaret
- CEIP-addictovigilance, CHU de Grenoble-Alpes, 38043 Grenoble, France
| | - Joëlle Micallef
- CEIP-addictovigilance, service de pharmacologie clinique et pharmacovigilance, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France; Aix-Marseille université, institut de neurosciences des systèmes, Inserm UMR1106, 13005 Marseille, France; Centre régional de pharmacovigilance, service de pharmacologie clinique et pharmacovigilance, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 13009 Marseille, France
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Serre A, Eiden C, Gourhant V, Laureau M, Perier D, Giraud I, Sebbane M, Peyrière H. [Involvement of addictovigilance in emergency department for the detection of abuse and dependence cases: 3 years of experience]. Therapie 2018; 73:501-509. [PMID: 30017376 DOI: 10.1016/j.therap.2018.06.002] [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: 04/05/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Due to the increase of hospitalization at emergency department (ED) related to psychoactive substances use (PSU), the addictovigilance center of Montpellier has been integrated into the URGEIM program for the detection of iatrogenic events at the ED. The objective of the present work was to analyze spontaneous reports (SR) collected via the URGEIM program. METHODS Analysis of spontaneous reports related to PSU at the ED of the Montpellier University Hospital, collected through the URGEIM program, between January 2014 and December 2016. RESULTS During the study period, 160 SR were collected through the URGEIM program on 1118 SR collected by the Addictovigilance center over the period: 40SR/342 in 2014, 46 SR/303 in 2015 and 74 SR/473 in 2016. Most patients were male (70%) and the mean age at admission was 33 years old. A total of 240 psychoactive substances were identified with 160 illicit substances (66.6%) [cocaine 38.1%, cannabis 30.6%] and 80 medications (33.3%) [buprenorphine 22.5%, benzodiazepines 20% and methadone 18.8%]. Mental and behavioral disorders (20.0%), general health problems associated with substance use (17.5%), cardiovascular diseases (13.1%) and infectious diseases (12.5%) were the main reported effects. The duration of emergency stay was inferior to 12hours in 63.1% of cases and greater than 24hours in 12.5% of cases. In 69.4% of cases, the event was considered as serious. The outcome was unknown for 6.9% of patients. CONCLUSION The number of SR from ED has increased over the study period, with the notification of serious and worrying cases, and the possibility of setting up actions. The deployment of addictovigilance within clinical services is a significant factor for notification and quality of care.
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Affiliation(s)
- Anaïs Serre
- Département de pharmacologie médicale et toxicologie, centre d'addictovigilance, hôpital Lapeyronie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Céline Eiden
- Département de pharmacologie médicale et toxicologie, centre d'addictovigilance, hôpital Lapeyronie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Vincent Gourhant
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Marion Laureau
- Département de pharmacie clinique et dispensation, pharmacie, centre hospitalier universitaire, 34295 Montpellier, France
| | - Damien Perier
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Isabelle Giraud
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Mustapha Sebbane
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Hélène Peyrière
- Département de pharmacologie médicale et toxicologie, centre d'addictovigilance, hôpital Lapeyronie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Ponté C, Lepelley M, Boucherie Q, Mallaret M, Lapeyre Mestre M, Pradel V, Micallef J. Doctor shopping of opioid analgesics relative to benzodiazepines: A pharmacoepidemiological study among 11.7 million inhabitants in the French countries. Drug Alcohol Depend 2018; 187:88-94. [PMID: 29649695 DOI: 10.1016/j.drugalcdep.2018.01.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The abuse of prescription opioids and its subsequent consequences is an important public concern particularly in the USA. The literature on opioid analgesic abuse is scarce. OBJECTIVE We assess the extent and risk of opioid analgesics abuse relative to benzodiazepines (BZD) using the doctor shopping method, taken into account the pharmacological characteristics (dosage, route of administration, extended or immediate release). METHODS We used SNIIRAM database covering 11.7 million inhabitants. All individuals with at least one reimbursement for non-injectable opioid analgesic or BZD in 2013 were included. Opioids for mild to moderate pain and for moderately severe to severe pain were studied. The Doctor Shopping Quantity (DSQ) is the quantity obtained by overlapping prescriptions from several prescribers. The Doctor Shopping Indicator (DSI) is the DSQ divided by the total dispensed quantity. RESULTS The strong opioid analgesics have the highest DSI (2.79%) versus 2.06% for BZD hypnotics. Flunitrazepam ranked first according to its DSI (13.2%), followed by morphine (4%), and zolpidem (2.2%). The three-strong opioids having the highest DSI were morphine, oxycodone and fentanyl (respectively 4%, 1.7% and 1.5%). The highest DSI was observed for the highest dosages of morphine (DSI = 8.4% for 200 mg) and oxycodone (DSI = 2.8% for 80 mg). The highest DSI for fentanyl was described with nasal and transmucosal forms (4.1% and 3.3% respectively). The highest DSI for morphine was described for extended-release (4.1%). CONCLUSION There is a need to reinforce surveillance systems to track opioid misuse and to increase awareness of healthcare professionals.
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Affiliation(s)
- Camille Ponté
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CIC 1436, UMR 1027 Inserm-Université Paul Sabatier Toulouse III, France
| | - Marion Lepelley
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance, Centre hospitalo-universitaire de Grenoble, 38043 Grenoble cedex, France
| | - Quentin Boucherie
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse, Service de Pharmacologie clinique, Aix-Marseille Université, Institut des Neurosciences des Systèmes UMR INSERM 1106, Marseille, France
| | - Michel Mallaret
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance, Centre hospitalo-universitaire de Grenoble, 38043 Grenoble cedex, France
| | - Maryse Lapeyre Mestre
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CIC 1436, UMR 1027 Inserm-Université Paul Sabatier Toulouse III, France
| | - Vincent Pradel
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse, Centre Associé, hôpital Sainte Marguerite, Laboratoire de Santé Publique, Faculté de médecine, EA 3279, Marseille, France
| | - Joëlle Micallef
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse, Service de Pharmacologie clinique, Aix-Marseille Université, Institut des Neurosciences des Systèmes UMR INSERM 1106, Marseille, France.
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Frauger E, Spadari M, Pochard L, Fouilhé Sam-Laï N, Jouanjus E, Mallaret M, Micallef J. Quels sont les principaux faits marquants des 9 ans de suivi d’addictovigilance de la méthadone ? TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2018. [DOI: 10.1016/j.toxac.2018.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schifano F, Chiappini S, Corkery JM, Guirguis A. Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review. Brain Sci 2018; 8:E73. [PMID: 29690558 PMCID: PMC5924409 DOI: 10.3390/brainsci8040073] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/11/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023] Open
Abstract
Recently, a range of prescription and over-the-counter drugs have been reportedly used as Novel Psychoactive Substances (NPS), due to their potential for abuse resulting from their high dosage/idiosyncratic methods of self-administration. This paper provides a systematic review of the topic, focusing on a range of medications which have emerged as being used recreationally, either on their own or in combination with NPS. Among gabapentinoids, pregabalin may present with higher addictive liability levels than gabapentin, with pregabalin being mostly identified in the context of opioid, polydrug intake. For antidepressants, their dopaminergic, stimulant-like, bupropion activities may explain their recreational value and diversion from the therapeutic intended use. In some vulnerable clients, a high dosage of venlafaxine (‘baby ecstasy’) is ingested for recreational purposes, whilst the occurrence of a clinically-relevant withdrawal syndrome may be a significant issue for all venlafaxine-treated patients. Considering second generation antipsychotics, olanzapine appears to be ingested at very large dosages as an ‘ideal trip terminator’, whilst the immediate-release quetiapine formulation may possess proper abuse liability levels. Within the image- and performance- enhancing drugs (IPEDs) group, the beta-2 agonist clenbuterol (‘size zero pill’) is reported to be self-administered for aggressive slimming purposes. Finally, high/very high dosage ingestion of the antidiarrhoeal loperamide has shown recent increasing levels of popularity due to its central recreational, anti-withdrawal, opiatergic effects. The emerging abuse of prescription drugs within the context of a rapidly modifying drug scenario represents a challenge for psychiatry, public health and drug-control policies.
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Affiliation(s)
- Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
| | - John M Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
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