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Roux P, Faye A, Sagaon-Teyssier L, Donadille C, Briand Madrid L, Carrieri MP, Maradan G, Jauffret-Roustide M, Lalanne L, Auriacombe M. Prevalence of stimulant use and the role of opioid agonist treatment among people who inject drugs in France: Results from the COSINUS cohort study. Drug Alcohol Rev 2024. [PMID: 39353607 DOI: 10.1111/dar.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 07/19/2024] [Accepted: 09/02/2024] [Indexed: 10/04/2024]
Abstract
INTRODUCTION The co-use of stimulants and opioids, including opioid agonist treatment (OAT), is very prevalent worldwide. A large body of data exists on the association between stimulant use and its health complications, and on OAT effectiveness among people with opioid use disorder. However, few data exist on stimulant-opioid co-use among people receiving OAT. Using data from the COSINUS cohort study, we investigated the association between the type of OAT and problematic stimulant use among persons who inject drugs (PWID). METHODS COSINUS is a 12-month French cohort study of 665 PWID. Data were collected in face-to-face interviews at enrolment, at 6 and 12 months. We defined problematic stimulant use as daily use of and/or injecting stimulants. We used Bayesian model averaging (BMA) to identify factors associated with problematic stimulant use. RESULTS At baseline, 76% (n = 505) of the participants reported problematic stimulant use. The optimal model from the BMA estimation showed that, after adjusting on social precarity and daily injection, participants on prescribed morphine sulfate as an OAT (compared with methadone) and those who use daily unprescribed buprenorphine were less likely to report problematic stimulant use. DISCUSSION AND CONCLUSIONS Our work highlights the high prevalence of problematic stimulant use among PWID in France but also the potential association between the type of OAT taken and stimulant use, by suggesting a protective effect of morphine sulfate on stimulant use. Since it has a higher intrinsic activity than other opioids, PWID on this OAT may be less interested in stimulants. Our findings warrant further investigation in clinical studies.
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Affiliation(s)
- Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Aissatou Faye
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Cécile Donadille
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Laélia Briand Madrid
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Maria Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Gwenaelle Maradan
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Jauffret-Roustide
- Centre d'étude des mouvements sociaux (Inserm U1276/UMR CNRS 8044/EHESS/Paris), Paris, France
- British Columbia Center on Substance Use, Vancouver, Canada
- Baldy Center on Law and Social Policy, Buffalo University, New York, USA
- Institut Universitaire sur les Dépendances, Montréal, Canada
| | - Laurence Lalanne
- INSERM 1329, Centre de recherche en biomédecine de Strasbourg, Strasbourg Cedex, France
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Marc Auriacombe
- University of Bordeaux, Bordeaux, France
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Addiction Team (Laboratoire de psychiatrie)/SANPSY, CNRS USR 3413, Bordeaux, France
- Pôle inter-établissement Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
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Bertin C, Dècle P, Chappard P, Roux P, Authier N. People who inject oral morphine favor experimentation with injectable opioid substitution. Harm Reduct J 2023; 20:130. [PMID: 37700290 PMCID: PMC10496178 DOI: 10.1186/s12954-023-00866-y] [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: 05/17/2023] [Accepted: 09/02/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The French Addictovigilance network has observed the existence of the intravenous use of oral morphine capsules among people suffering from opioid use disorders. According to persons who inject morphine, these capsules are easy to dissolve and then inject, giving them the image of an "injectable" opioid substitution treatment (OST). In France, validated OSTs are only available orally, so dissolving morphine capsules represents the only alternative for patients who are not sufficiently relieved by oral forms. This practice presents risks related to the potential persistence of particles of the oral galenic in the injectable solution, despite its filtration, but also risks-notably of overdose-related to the pharmacological effects of opioids and to variations of the quantities of morphine extracted during the dissolution of the capsules. We conducted an online survey among the people concerned to collect data on their needs and expectations regarding a possible injectable substitution. METHOD An anonymous online survey including all voluntary respondents residing in France and using oral morphine intravenously was conducted in partnership with the Psychoactif harm reduction organization, from 23/03/2020 to 01/04/2021. RESULTS The analysis of the 157 exploitable questionnaires showed that 41% of the respondents obtained their drugs only from illegal markets. The others received, regularly or occasionally, medical prescriptions, reimbursed in 84% of cases. For 78% of the respondents, injection was the most frequent route of morphine administration, with 3.8 ± 2 injections per day. 56% of the respondents were receiving an OST, on prescription (79%), monthly (86%), in addition to morphine. Skenan® capsules were the most frequently used (81%) and 47.2% of the respondents had already experienced injection-related complications. 95% of the respondents were in favor of experimenting with an injectable morphine substitution. Those who never received medical prescriptions were the youngest (< 25 years) respondents, they reported only occasional use of morphine, and always intravenously. CONCLUSION Oral morphine capsules dissolved and injected intravenously are not a safe and sustainable injectable substitution. Respondents wish to be able to benefit from an injectable substitution with a formulation adapted to the intravenous route. The availability of an injectable substitution would facilitate harm reduction and entry into care for the people concerned, particularly the youngest who have never received morphine prescriptions.
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Affiliation(s)
- Célian Bertin
- 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, BP-69, CHU Gabriel Montpied, 58 Rue Montalembert, 63000, Clermont Ferrand, France.
- Observatoire Français des Médicaments Antalgiques (OFMA), French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France.
- Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France.
| | - Philémon Dècle
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
- Association PsychoACTIF, Marseille, France
| | | | - Perrine Roux
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
| | - Nicolas Authier
- 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, BP-69, CHU Gabriel Montpied, 58 Rue Montalembert, 63000, Clermont Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
- Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
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Duthie K, Mathison E, Eyford H, Ghosh SM. Prescribing safe supply: ethical considerations for clinicians. JOURNAL OF MEDICAL ETHICS 2023; 49:377-382. [PMID: 35985806 DOI: 10.1136/jme-2021-108087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/11/2022] [Indexed: 05/24/2023]
Abstract
The COVID-19 pandemic has exacerbated the drug poisoning epidemic in a number of ways: individuals use alone more often, there is decreased access to harm reduction services and there has been an increase in the toxicity of the unregulated drug supply. In response to the crisis, clinicians, policy makers and people who use drugs have been seeking ways to prevent the worst harms of unregulated opioid use. One prominent idea is safe supply. One form of safe supply enlists clinicians to prescribe opioids so that people have access to drugs of known composition and strength. In this paper, we assess the ethical case for clinicians providing this service. As we describe, there is much that is unknown about safe supply. However, given the seriousness of the overdose death epidemic and the current limited evidence for safe supply's efficacy, we argue that it is ethically permissible for clinicians to begin prescribing opioids for some select patients.
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Affiliation(s)
- Katherine Duthie
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Mathison
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada
- Department of Philosophy, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Helgi Eyford
- Clinical Ethics Service, Alberta Health Services, Edmonton, Alberta, Canada
| | - S Monty Ghosh
- Addictions Services, Alberta Health Services, Calgary, Alberta, Canada
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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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Bertin C, Bezin J, Chenaf C, Delorme J, Kerckhove N, Pariente A, Tournier M, Authier N. Oral Morphine as an Alternative Substitution Treatment for Opioid Use Disorder, a Rare but Non-risk-free Use. Front Psychiatry 2022; 13:893590. [PMID: 35845444 PMCID: PMC9282723 DOI: 10.3389/fpsyt.2022.893590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background National health monitoring agencies have reported the alternative use of morphine sulfate painkiller for maintenance treatment of opioid use disorder (OUD), associated with a potential increase in overdose risk. Objectives This study sought to assess the prevalence of regular and occasional legally prescribed morphine use in patients treated for OUD and compare their characteristics to those of patients receiving conventional opioid maintenance treatment (OMT), buprenorphine or methadone. Then, we assessed the factors associated with opioid overdose risk. Methods Data were extracted from the French national healthcare system database, covering the entire population in 2015. Diagnosis associated with hospital discharge and long-term disease codes were extracted to select the population and identify outcomes and covariates. OUD non-chronic pain patients were divided into regular (≤35 days between dispensing and ≥3 months of continuous treatment duration) morphine users, and occasional users. Their sociodemographic and health characteristics were compared to OMT controls. A multivariate logistic regression model was performed to determine factors associated with opioid overdose. Results In patients treated for OUD, 2,237 (2.2%) morphine users (1,288 regular and 949 occasional), 64,578 (63.7%) buprenorphine and 34,638 (34.1%) methadone controls were included. The prevalence of regular morphine use among patients treated for OUD regularly receiving an opioid was 1.3%. Compared to users who receive morphine regularly, occasional users had an increased risk of overdose [OR = 2.2 (1.5-3.3)], while the risk was reduced in the buprenorphine group [OR = 0.5 (0.4-0.7)] and not significantly different for methadone [OR = 1.0 (0.7-1.4)]. Other overdose risk factors were low-income, comorbidity, i.e., psychiatric conditions, alcohol use disorder or complications related to intravenous drug use, and coprescription with benzodiazepines or pregabalin. These factors were more frequent in morphine groups. Conclusions Patients that were prescribed oral morphine represented a small minority of the treated for OUD. The poorer health condition affected by numerous comorbidities and higher risk of opioid overdose in patients treated with oral morphine compared with OMT controls points toward the need to better supervise the practices of these patients, to strengthen multidisciplinary care and risk reduction measures.
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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, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Julien Bezin
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
- Service de Pharmacologie médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Chouki Chenaf
- 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, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
| | - Jessica Delorme
- 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, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
| | - Nicolas Kerckhove
- 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, Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Antoine Pariente
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
- Service de Pharmacologie médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Marie Tournier
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
- Hospital Charles Perrens, Bordeaux, 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, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
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Bertin C, Delorme J, Riquelme M, Peyrière H, Brousse G, Eschalier A, Ardid D, Chenaf C, Authier N. Risk assessment of using off-label morphine sulfate in a population-based retrospective cohort of opioid-dependent patients. Br J Clin Pharmacol 2020; 86:2338-2348. [PMID: 31389036 PMCID: PMC7688539 DOI: 10.1111/bcp.14082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 05/02/2019] [Accepted: 07/19/2019] [Indexed: 01/09/2023] Open
Abstract
AIMS Several addictovigilance studies have described the off-label use of morphine sulfate (MS) for nonchronic pain in opioid use disorder (OUD) patients as an alternative to conventional opioid substitution treatments (OSTs). This study primarily sought to compare the incidence of unintentional opioid-related overdose in the year following the prescription initiation in off-label MS users, compared to OST-maintained patients. METHODS Sequential cohorts of OUD patients who were regularly dispensed MS, buprenorphine, or methadone, between 1 April 2012 and 31 December 2014, were retrospectively identified using the French nationwide healthcare data system. The incidence of overdoses, deaths, doctor shopping, and complications of a viral, bacterial or thrombotic nature, was compared using the Cox regression method. RESULTS Overall, 1075, 20 834 and 9778 OUD patients without chronic-pain were included in the MS, buprenorphine, and methadone cohorts, respectively. Overdose incidence was 3.8 (P < .01 [95% confidence interval (CI): 2.1-6.8]) and 2.0 (P = .02 [95%CI: 1.1-3.6]) higher in the MS cohort vs buprenorphine and methadone, respectively. Death incidence was 9.1 (P < .01 [95%CI: 3.2-25.9]) and 3.9 (P < .01 [95%CI: 1.4-10.7]) higher in the MS cohort vs buprenorphine and methadone, respectively. The incidences of other associated risks were significantly higher in the MS group vs OSTs, except for hepatitis C viral infection and thrombotic complications. CONCLUSION This first French comprehensive nationwide study reveals increasing overdose, death, bacterial infection, abuse and diversion risks when off-label MS is initiated as alternative to OST. These results question the relevance of prescribing MS as a safe opioid maintenance treatment, considering its health risk profile.
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Affiliation(s)
- Célian Bertin
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
| | - Jessica Delorme
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
| | - Marie Riquelme
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
| | - Hélène Peyrière
- CHU Montpellier, Laboratoire de Pharmacie Clinique, Département de Pharmacologie Médicale et Toxicologie, Centre AddictovigilanceUniversité de MontpellierMontpellierFrance
| | - Georges Brousse
- CIRCEA, Service de Psychiatrie‐addictologieUniversité Clermont AuvergneClermont‐FerrandFrance
| | - Alain Eschalier
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
- Faculté de MédecineInstitut AnalgesiaClermont‐FerrandFrance
| | - Denis Ardid
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
- Faculté de MédecineInstitut AnalgesiaClermont‐FerrandFrance
| | - Chouki Chenaf
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
| | - Nicolas Authier
- CHU Clermont‐Ferrand, Inserm 1107, Neuro‐Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la DouleurUniversité Clermont AuvergneClermont‐FerrandFrance
- Observatoire Français des Médicaments Antalgiques (OFMA)CHU Clermont‐Ferrand and Université Clermont AuvergneClermont–FerrandFrance
- Faculté de MédecineInstitut AnalgesiaClermont‐FerrandFrance
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Bromley LA. Problems with hydromorphone prescribing as a response to the opioid crisis. CMAJ 2020; 192:E219-E220. [PMID: 32122979 DOI: 10.1503/cmaj.74065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Lisa A Bromley
- Physician, The Ottawa Hospital; Sandy Hill Community Health Centre, Ottawa, Ont
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