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Nakamura T, Furihata R, Hasegawa N, Kodaka F, Muraoka H, Ichihashi K, Ochi S, Numata S, Tsuboi T, Makinodan M, Iida H, Onitsuka T, Kashiwagi H, Takeshima M, Hashimoto N, Nagasawa T, Usami M, Yamagata H, Takaesu Y, Miura K, Matsumoto J, Ohi K, Yamada H, Hori H, Inada K, Watanabe K, Hashimoto R, Yasui-Furukori N. The effect of education regarding treatment guidelines for schizophrenia and major depressive disorders on psychiatrists' hypnotic medication prescribing behavior: a multicenter study. BMC Psychiatry 2024; 24:399. [PMID: 38807065 PMCID: PMC11135008 DOI: 10.1186/s12888-024-05816-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/05/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To examine whether the "Effectiveness of Guideline for Dissemination and Education in psychiatric treatment (EGIUDE)" project affects the rate of prescriptions of hypnotic medication and the type of hypnotic medications prescribed among psychiatrists, for schizophrenia and major depressive disorder in Japan. METHODS The EGUIDE project is a nationwide prospective study of evidence-based clinical guidelines for schizophrenia and major depressive disorder in Japan. From 2016 to 2021, clinical and prescribing data from patients discharged from hospitals participating in the EGUIDE project were used to examine hypnotic medication prescriptions The prescribing rate of hypnotics and the prescribing rate of each type of hypnotic (benzodiazepine receptor agonist, nonbenzodiazepine receptor agonist, melatonin receptor agonist, and orexin receptor antagonist) were compared among patients who had been prescribed medication by psychiatrists participating in the EGUIDE project and patients who had been prescribed medication by nonparticipating psychiatrists. Multivariate logistic regression analysis was performed to examine the effect of the EGUIDE project on the prescription of hypnotic medications. RESULTS A total of 12,161 patients with schizophrenia and 6,167 patients with major depressive disorder were included. Psychiatrists participating in the EGUIDE project significantly reduced the rate of prescribing hypnotic medication and benzodiazepine receptor agonists for both schizophrenia (P < 0.001) and major depressive disorder (P < 0.001) patients. CONCLUSION This is the first study to investigate the educational effects of guidelines for the treatment of psychiatric disorders on psychiatrists in terms of prescribing hypnotic medications to patients. The EGUIDE project may play an important role in reducing hypnotic medication prescription rates, particularly with respect to benzodiazepine receptor agonists. The results suggest that the EGUIDE project may result in improved therapeutic behavior.
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Affiliation(s)
- Toshinori Nakamura
- Department of Psychiatry, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Yoshida-Honmachi, Kyoto, 606-8501, Japan
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
| | - Fumitoshi Kodaka
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
- Department of Psychiatry, The Jikei University School of Medicine, 3-18-13 Nishi-Shinbashi, Minato, 105-8471, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, Kitasato University School of Medicine, 1-15-1 Kitazato, Sagamihara, 252-0373, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, 113-8655, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, 791-0295, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, 3-8-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, 181-8611, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Fukuoka, 814-0180, Japan
| | - Toshiaki Onitsuka
- NHO Sakakibara National Hospital, 777 Sakakibara-cho, Tsu, 514-1292, Japan
| | - Hiroko Kashiwagi
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
- Department of Forensic Psychiatry, National Center Hospital, National Center of Psychiatry and Neurology, 4-1-1 Ogawahigashi, Kodaira, 187-8551, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Sapporo, 060-8638, Japan
| | - Tatsuya Nagasawa
- Department of Neuropsychiatry, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, 272-8516, Japan
| | - Hirotaka Yamagata
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
- Kokoro Hospital Machida, 2140 Kamioyamadamachi, Machida, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, 903-0215, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hisashi Yamada
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
- Department of Neuropsychiatry, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Fukuoka, 814-0180, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, 1-15-1 Kitazato, Sagamihara, 252-0373, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, 181-8611, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, 187-8553, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, 321-0293, Japan.
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Istvan M, Duval M, Hodel K, Aquizerate A, Chaslerie A, Artarit P, Laforgue EJ, Victorri-Vigneau C. Evolution of the profiles of new psychotropic drug users before and during the COVID-19 crisis: an original longitudinal approach through multichannel sequence analysis using the French health-care database. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01774-3. [PMID: 38499795 DOI: 10.1007/s00406-024-01774-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 02/02/2024] [Indexed: 03/20/2024]
Abstract
The COVID-19 pandemic has had a substantial impact on mental health. An increase in the use of anxiolytic, hypnotic, and antidepressant drugs has been highlighted in France, but with no information at the individual level (trajectories) or concerning patient characteristics. The objective of this study was to describe the profile of new psychotropic drug users since the beginning of the pandemic. We formed two historical cohorts using the Pays-de-la-Loire regional component of the National Health Data System (SNDS): a "COVID-19 crisis cohort" (2020-2021) and a "control cohort" (2018-2019). We analyzed reimbursements for psychotropic medications (anxiolytics, antidepressants, hypnotics, mood stabilizers, and antipsychotics) using a multichannel sequence analysis and performed clustering analysis of sequences. The proportion of new consumers of psychotropic drugs was higher in the COVID-19 crisis cohort (18.0%) than that in the control cohort (16.0%). In the COVID-19 cohort, three clusters of psychotropic drug users were identified, whereas four clusters were identified in the control cohort. A time lag in treatment initiation was observed in the COVID-19 crisis cohort (September) compared with the control cohort (July). This study is one of the first to analyze the profile of psychotropic treatment users during the COVID-19 crisis. Our analysis sheds light on changes in patterns of psychotropic drug use during the COVID-19 pandemic, possibly associated with changes in prescribing conditions and mental health conditions during the crisis. This study also provides an example of the application of an innovative longitudinal analysis methodology in the field of pharmacoepidemiology.
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Affiliation(s)
- Marion Istvan
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France.
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France.
| | - Mélanie Duval
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
| | - Karl Hodel
- Direction Régionale du Service Médical des Pays de la Loire, F-44034, Nantes, France
| | - Aurélie Aquizerate
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
| | - Anicet Chaslerie
- Direction Régionale du Service Médical des Pays de la Loire, F-44034, Nantes, France
| | - Pascal Artarit
- Direction Régionale du Service Médical des Pays de la Loire, F-44034, Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, F-44000, Nantes, France
- Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000, Nantes, France
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Lasys T, Santa-Ana-Tellez Y, Siiskonen SJ, Groenwold RHH, Gardarsdottir H. Unintended impact of pharmacovigilance regulatory interventions: A systematic review. Br J Clin Pharmacol 2023; 89:3491-3502. [PMID: 37553757 DOI: 10.1111/bcp.15874] [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: 03/13/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
AIMS Studies assessing the impact of pharmacovigilance regulatory interventions often focus on the expected (or intended) outcomes, while any possible unintended impact may be overlooked. The update of the Good Pharmacovigilance Practice guideline in 2017 elaborated on impact assessment, emphasizing the need also to assess possible unintended impact. This systematic literature review investigated how often the unintended impact of regulatory interventions was considered in publications of studies investigating pharmacovigilance regulatory interventions in Europe. METHODS We conducted a systematic review of the literature on MEDLINE and EMBASE from 1 January 2012 to 28 February 2022 to identify publications that investigated the impact of regulatory interventions in Europe. The primary outcome of the study was the number of publications reporting assessments of unintended impact. In addition, we studied the characteristics of these publications, including the type of outcomes assessed, the analytical methods applied and the type of data used. RESULTS In total, 96 publications were included in the analysis. The unintended impact of pharmacovigilance regulatory interventions was investigated in 23 of 96 publications (24%). The drug classes most frequently studied in the publications assessing unintended impact of regulatory interventions were oral glucose-lowering drugs (n = 6, 26%), opioids (n = 4, 17%), antidepressants (n = 4, 17%) and antipsychotics (n = 3, 13%). The reported methods to assess the unintended impact were interrupted time series (n = 10, 43%) and descriptive statistics with or without significance testing (n = 2 [9%] and n = 9 [39%], respectively). The outcomes selected for unintended impact assessments included the use of other drugs (n = 16, 70%), health outcomes (n = 8, 35%) and behavioural changes (n = 4, 17%). Most of the publications reported on the use of electronic health record databases (n = 13, 57%) or claims databases (n = 13, 57%), while registries were used in 4 publications (17%). CONCLUSION The unintended impact of pharmacovigilance regulatory interventions was reported in only a quarter of identified publications. There was no apparent increase in attention to unintended impact assessments after the update of the Good Pharmacovigilance Practice guidelines.
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Affiliation(s)
- Tomas Lasys
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Yared Santa-Ana-Tellez
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Satu J Siiskonen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Department of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
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Soeiro T, Pradel V, Lapeyre-Mestre M, Micallef J. Systematic assessment of non-medical use of prescription drugs using doctor-shopping indicators: A nation-wide, repeated cross-sectional study. Addiction 2023; 118:1984-1993. [PMID: 37203878 DOI: 10.1111/add.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
AIMS The aim of this study was to present the first nation-wide, systematic, repeated assessment of doctor-shopping (i.e. visiting multiple physicians to be prescribed the same drug) during 10 years for more than 200 psychoactive prescription drugs in the 67 million inhabitants in France. DESIGN This was a nation-wide, repeated cross-sectional study. SETTING AND PARTICIPANTS Data are from the French National Health Data System in 2010, 2015 and 2019 for 214 psychoactive prescription drugs (i.e. anaesthetics, analgesics, antiepileptics, anti-Parkinson drugs, psycholeptics, psychoanaleptics, other nervous system drugs and antihistamines for systemic use). MEASUREMENTS The detection and quantification of doctor-shopping relied upon an algorithm that detects overlapping prescriptions from repeated visits to different physicians. We used two doctor-shopping indicators aggregated at population level for each drug dispensed to more than 5000 patients: (i) the quantity doctor-shopped, expressed in defined daily doses (DDD), which measures the total quantity doctor-shopped by the study population for a given drug; and (ii) the proportion doctor-shopped, expressed as a percentage, which standardizes the quantity doctor-shopped according to the use level of the drug. FINDINGS The analyses included approximately 200 million dispensings to approximately 30 million patients each year. Opioids (e.g. buprenorphine, methadone, morphine, oxycodone and fentanyl), benzodiazepines and non-benzodiazepine hypnotics (Z-drugs) (e.g. diazepam, oxazepam, zolpidem and clonazepam) had the highest proportions doctor-shopped during the study period. In most cases, the proportion and the quantity doctor-shopped increased for opioids and decreased for benzodiazepines and Z-drugs. Pregabalin had the sharpest increase in the proportion doctor-shopped (from 0.28 to 1.40%), in parallel with a sharp increase in the quantity doctor-shopped (+843%, from 0.7 to 6.6 DDD/100 000 inhabitants/day). Oxycodone had the sharpest increase in the quantity doctor-shopped (+1000%, from 0.1 to 1.1 DDD/100 000 inhabitants/day), in parallel with a sharp increase in the proportion doctor-shopped (from 0.71 to 1.41%). Detailed results for all drugs during the study period can be explored interactively at: https://soeiro.gitlab.io/megadose/. CONCLUSIONS In France, doctor-shopping occurs for many drugs from many pharmacological classes, and mainly involves opioid maintenance drugs, some opioids analgesics, some benzodiazepines and Z-drugs and pregabalin.
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, Marseille, France
- Unité de pharmacoépidémiologie, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
| | - Vincent Pradel
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
| | - Maryse Lapeyre-Mestre
- Université de Toulouse, Inserm, Toulouse, France
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, Marseille, France
- Unité de pharmacoépidémiologie, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
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Soyka M, Wild I, Caulet B, Leontiou C, Lugoboni F, Hajak G. Long-term use of benzodiazepines in chronic insomnia: a European perspective. Front Psychiatry 2023; 14:1212028. [PMID: 37599882 PMCID: PMC10433200 DOI: 10.3389/fpsyt.2023.1212028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Chronic insomnia occurs in ~10% of the general population and has numerous negative health effects. The recommended first line treatment of cognitive behavior therapy for insomnia is not widely available for patients in Europe, so pharmacotherapies such as benzodiazepine receptor agonist agents (benzodiazepines and Z-drugs) are commonly used. However, their use is only recommended for ≤4 weeks due to unproven long-term efficacy in treatment of chronic insomnia, and the risk of tolerance, and the potential for dependence and misuse. In Europe, recommendations limiting the use of benzodiazepines (lowest dose and shortest duration) in chronic insomnia are not always followed, likely due to the lack of approved effective alternative therapies. Here we present a recent pilot survey of the pharmacological treatment landscape in chronic insomnia in five European countries (France, Germany, Italy, Spain, and the United Kingdom) and physicians' attitude toward treatment. The results suggest that benzodiazepines and Z-drugs are the most widely used treatments in chronic insomnia and are being used for longer than their recommended duration. Country variations in prescription rates were observed. Due to the known association between long-term benzodiazepine use and potential for developing dependence, further analysis of the literature was performed on the use and misuse of benzodiazepines. The results show that long-term use of benzodiazepines is associated with multiple consequences of treatment, including dependence, but also that previous use of benzodiazepines may increase the risk of opioid use disorder.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Imane Wild
- Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | | | | | - Fabio Lugoboni
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona, Italy
| | - Göran Hajak
- University of Regensburg, Regensburg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, Bamberg, Germany
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Siafis S, Fountoulakis KN, Fragkidis V, Papazisis G. Prescribing Z-drugs in Greece: an analysis of the national prescription database from 2018 to 2021. BMC Psychiatry 2023; 23:370. [PMID: 37237252 DOI: 10.1186/s12888-023-04793-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The Z-drugs are indicated for the short-treatment of insomnia, but they are associated with abuse, dependence and side-effects. There are only sparse data about Z-drug prescribing in Greece. METHODS We analyzed data from the Greek prescription database, considering prescriptions for the available Z-drugs in Greece, i.e., zolpidem and zopiclone, during the period from 01.10.2018 to 01.10.2021 in order to examine the prevalence, monthly number and characteristics of Z-drug prescriptions in Greece. RESULTS There were 1,229,842 prescriptions for Z-drugs (zolpidem: 89.7%) during the investigated period from 2018 to 2021, which corresponded to 156,554 patients (73.1% ≥ 65 years, 64.5% female). More than half of the patients (65.8%) had more than one prescription with a median number of 8, interquartile range IQR [3, 17], prescriptions during the three-year study period. Most patients (76.1%) were prescribed by medical specialties other than psychiatrists and neurologists, despite a considerable frequency of psychiatric comorbidities (53.7%). About half of patients with anxiety/depression were not prescribed anxiolytics or antidepressants, a practice more frequently observed among medical specialties other than psychiatrists and neurologists. The average annual prevalence of at least one prescription for Z-drugs in the Greek population during 2019-2020 was approximately 0.9% (higher in females and older adults). The monthly number of prescriptions was relatively stable with a median number of 334.2 IQR [310.4; 351.6] prescriptions per 100,000 persons. CONCLUSIONS A considerable number of patients are prescribed Z-drugs in Greece, more often older adults, females and patients with psychiatric comorbidities. The prescribing physicians were in the majority (70%) internists and general practitioners, while psychiatrists (10.9%) and neurologists (6.1%) accounted for a smaller proportion. Due to the limitations inherent to medical claims databases, further research is warranted in order to elucidate the potential abuse and misuse of Z-drugs.
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Affiliation(s)
- Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Fragkidis
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Clinical Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Aquizerate A, Laforgue EJ, Istvan M, Rousselet M, Gerardin M, Jouanjus E, Libert F, Guerlais M, Victorri-Vigneau C. French national addictovigilance follow-up of zolpidem between 2014 and 2020: evolution of drug abuse, misuse and dependence before and after the regulatory change. Eur J Public Health 2023; 33:169-175. [PMID: 36749030 PMCID: PMC10066475 DOI: 10.1093/eurpub/ckad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Since the appearance of zolpidem on the market, the occurrence of serious cases of abuse, misuse and dependence have come to the attention of authorities. In view of the increase in the number and severity of cases among zolpidem users and the predominant presence of zolpidem in falsified prescriptions, the French Health Authorities implemented part of the narcotics regulation for zolpidem in April 2017. The objective of this article was to describe the evolution of the abuse, dependence and misuse of zolpidem. METHODS We used three data sources: (i) zolpidem is a reimbursable and strictly prescription drug in France. Medic'AM is a public database that indicates the number of tablets reimbursed each month in France for each reimbursable drug. This database has been analyzed as a proxy of the exposure of the French population to zolpidem; (ii) all French cases of drug dependence or abuse reported by health professionals (regulatory obligation) and (iii) an epidemiological tool based on the surveillance of falsified prescriptions over two periods: the 3-year period before the regulatory measure (2014-16) and the 3-year period after the regulatory measure (2018-20). RESULTS This regulatory change had two immediate consequences: a sharp decline in falsified prescriptions and a decrease of ∼57% between the two study periods in the zolpidem reimbursement data. Markers of problematic consumption remained after the regulatory change with worsening cases, particularly for people who were genuinely dependent and/or had comorbidities or misusers for whom zolpidem was the substance of interest, whose proportion increased significantly in the addictovigilance notification system, from 43.6% (N = 107) to 59.3% (N = 127) (P < 0.01). CONCLUSIONS Further monitoring is needed in light of these persistent markers of problematic consumption.
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Affiliation(s)
- Aurélie Aquizerate
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France.,Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-centered outcomes and HEalth ResEarch, SPHERE, Nantes F-44000, France
| | - Marion Istvan
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France.,Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-centered outcomes and HEalth ResEarch, SPHERE, Nantes F-44000, France
| | - Morgane Rousselet
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France.,Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-centered outcomes and HEalth ResEarch, SPHERE, Nantes F-44000, France.,Nantes Université, CHU Nantes, Service d'Addictologie et de Psychiatrie de Liaison, Nantes, France
| | - Marie Gerardin
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France
| | - Emilie Jouanjus
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse
| | - Frédéric Libert
- Service de Pharmacologie Médicale, Université Clermont Auvergne, Centre Hospitalier Universitaire de Clermont-Ferrand
| | | | - Marylène Guerlais
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France.,Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-centered outcomes and HEalth ResEarch, SPHERE, Nantes F-44000, France
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8
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Laforgue EJ, Rousselet M, Claudon A, Aquizerate A, Jolliet P, Istvan M, Victorri-Vigneau C. Did the New French Regulation of Zolpidem Decrease the Problematic Consumption of Zolpidem? A Field Study among Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158920. [PMID: 35897285 PMCID: PMC9331950 DOI: 10.3390/ijerph19158920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 12/03/2022]
Abstract
Background: The French national drug regulatory authority stated, in 2017, that a secured prescription pad must be used for zolpidem prescriptions. This study aimed to evaluate the evolution of the problematic consumption of zolpidem at the individual level since the new regulation. Methods: Two nationwide populations of at-risk users of zolpidem were recruited: one in general practitioner (GP) offices and one in specialized care centers dedicated to drug dependence (SCDDs). Participants were asked about their zolpidem consumption before and after the regulation change. The primary outcome was the evolution of problematic zolpidem consumption, as defined by at least one of the following criteria: overconsumption, fraudulent ways of obtaining, effects sought other than hypnotic, and modes of administration other than oral. Results: A total of 243 participants were included: 125 from GP offices and 118 from SCDDs. In the GP population, the prevalence of patients who were identified as problematic consumers decreased from 24.8% to 20.8% (p = 0.593), whereas the prevalence decreased from 73.7% to 51.7% in the SCDD population (p < 0.001). The most prevalent criteria for problematic status were overconsumption and fraudulent ways. Conclusions: The new French regulation of zolpidem had different impacts among two different populations of at-risk zolpidem consumers.
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Affiliation(s)
- Edouard-Jules Laforgue
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
- Correspondence: ; Tel.: +33-2–4008-4073
| | - Morgane Rousselet
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, F-44000 Nantes, France
| | - Antoine Claudon
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
| | - Aurélie Aquizerate
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
| | - Pascale Jolliet
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
| | - Marion Istvan
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
| | - Caroline Victorri-Vigneau
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
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9
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Perception of the Regulatory Change for Zolpidem Prescription by French General Practitioners and Its Relation to Prescription Behavior. J Clin Med 2022; 11:jcm11082176. [PMID: 35456269 PMCID: PMC9032177 DOI: 10.3390/jcm11082176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background: To “limit the risk of abuse and misuse” and “encourage correct usage”, the French drug regulatory authority stated that—from April 2017—zolpidem prescription must be performed on a secured prescription pad. This national study aims to evaluate the perception of general practitioners (GPs) towards this new regulation and its link with prescription strategies. Methods: We conducted structured interviews of GPs. Data were collected about GPs’ perception of the measure and therapeutic strategies towards zolpidem. The primary outcome was the description of the GPs’ strategy of prescription, based on the perception towards the new regulation for zolpidem. Results: For 206 GPs, the new regulation was mainly perceived as helpful (61%) and as a difficulty (55%). Other perceptions were the awareness of the risks of zolpidem (18%), awareness of the risks of hypnotics (13%), and nothing changed (5%). Four clusters of GPs were identified. In the clusters with the perception as a difficulty (only or associated with helpful), the GPs who applied the strategy “no modification” for >50% of their patients were more frequently compared to awareness and helpful only clusters (60.8%; 42.9%; 20.4%; 26.7%) (p < 0.001). Conclusions: We highlighted an association between the perception of the new regulation of zolpidem prescription by GPs and a strategy of prescription.
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Steingrímsson S, Odéus E, Cederlund M, Franzén S, Helgesson C, Nyström K, Sondell J, Opheim A. Weighted blanket and sleep medication use among adults with psychiatric diagnosis - a population-based register study. Nord J Psychiatry 2022; 76:29-36. [PMID: 34106812 DOI: 10.1080/08039488.2021.1931713] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To measure rate of subscription of common sleep medication and diagnoses of substance use disorder (SUD) before and after receiving a prescribed weighted blanket (WB) among patients with psychiatric diagnoses. MATERIALS AND METHODS Using register-based data of health-related factors in a Swedish region, a total of 1785 adult individuals with a psychiatric diagnosis, received a WB and resided in the region during the study period were identified. Using each individual as their own control, the rate of one-year prior prescription of WB or diagnosed SUD was compared to rate after a half year wash-out after prescription of WB for a full year. RESULTS The number of patients without prescription of sleep medication increased by 3.3% (95% confidence interval (95%CI): 0.2-6.4, p=.04). Furthermore, the proportion without a prescription of benzodiazepine receptor agonist/antihistamines sleep medication increased by 5.5% (95%CI: 2.2-8.8, p=.001). Melatonin prescription increased after WB by 3.6% (95%CI: 1.1-6.2, p=.006). Younger age and unipolar-, anxiety-, attention-deficit/hyperactivity-, and post-traumatic stress disorder was associated with decreased use while psychotic-/bipolar- and personality disorder was not associated with a decrease in the use of sleep medication. The number of alcohol SUD diagnoses did not increase while sedative SUD rate increased statistically significantly by 0.7% (odds ratio = 1.63, p=.02). In a multivariate model, only younger age predicted discontinuation of sleep medication while psychotic-/bipolar- and personality disorder had statistically less decrease. CONCLUSION This observational register study found a statistically significant association between WB use and decreased use of common sleep medication except melatonin that increased slightly.
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Affiliation(s)
- Steinn Steingrímsson
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Psychiatry, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Ellen Odéus
- Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Region Västra Götaland, Queen Silvias Children's Hospital, Department of Occupational and Physiotherapy, Sweden
| | - Mats Cederlund
- Region Västra Götaland, Habilitation & Health, Gothenburg, Sweden
| | - Stefan Franzén
- Region Västra Götaland, The Swedish National Diabetes Register, Gothenburg, Sweden.,Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carina Helgesson
- Region Västra Götaland, Regional Primary Health Care Unit, Health Care Pharmacy and Medical Aid, Gothenburg, Sweden
| | - Kristina Nyström
- Region Västra Götaland, Habilitation & Health, Gothenburg, Sweden
| | - John Sondell
- Department of Data Management and Analysis, Head Office, Region Västra Götaland, Gothenburg, Sweden
| | - Arve Opheim
- Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden.,Region Västra Götaland, Habilitation & Health, Gothenburg, Sweden
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11
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Vanoli J, Nava CR, Airoldi C, Ucciero A, Salvi V, Barone-Adesi F. Use of State Sequence Analysis in Pharmacoepidemiology: A Tutorial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413398. [PMID: 34949007 PMCID: PMC8705850 DOI: 10.3390/ijerph182413398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022]
Abstract
While state sequence analysis (SSA) has been long used in social sciences, its use in pharmacoepidemiology is still in its infancy. Indeed, this technique is relatively easy to use, and its intrinsic visual nature may help investigators to untangle the latent information within prescription data, facilitating the individuation of specific patterns and possible inappropriate use of medications. In this paper, we provide an educational primer of the most important learning concepts and methods of SSA, including measurement of dissimilarities between sequences, the application of clustering methods to identify sequence patterns, the use of complexity measures for sequence patterns, the graphical visualization of sequences, and the use of SSA in predictive models. As a worked example, we present an application of SSA to opioid prescription patterns in patients with non-cancer pain, using real-world data from Italy. We show how SSA allows the identification of patterns in prescriptions in these data that might not be evident using standard statistical approaches and how these patterns are associated with future discontinuation of opioid therapy.
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Affiliation(s)
- Jacopo Vanoli
- London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, UK;
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki 852-8521, Japan
| | - Consuelo Rubina Nava
- Department of Economics and Statistics “Cognetti de Martiis”, University of Turin, 10124 Turin, Italy
- Correspondence:
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (C.A.); (A.U.)
| | - Andrealuna Ucciero
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (C.A.); (A.U.)
| | - Virginio Salvi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (V.S.); (F.B.-A.)
| | - Francesco Barone-Adesi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (V.S.); (F.B.-A.)
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12
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Istvan M, Laforgue EJ, Guerlais M, Jolliet P, Victorri-Vigneau C. ZORRO: When the mask falls off-Comment. Br J Clin Pharmacol 2021; 88:2450-2451. [PMID: 34610152 DOI: 10.1111/bcp.15086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 09/04/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Marion Istvan
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, Nantes, France.,UMR INSERM 1246, SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", University of Nantes, University of Tours, Nantes, France
| | - Edouard-Jules Laforgue
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, Nantes, France.,UMR INSERM 1246, SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", University of Nantes, University of Tours, Nantes, France
| | - Marylène Guerlais
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, Nantes, France
| | - Pascale Jolliet
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, Nantes, France.,UMR INSERM 1246, SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", University of Nantes, University of Tours, Nantes, France
| | - Caroline Victorri-Vigneau
- Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, Nantes University Hospital, Nantes, France.,UMR INSERM 1246, SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", University of Nantes, University of Tours, Nantes, France
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