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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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Espelt A, Bosque-Prous M, Folch C, Sarasa-Renedo A, Majó X, Casabona J, Brugal MT. Is systematic training in opioid overdose prevention effective? PLoS One 2017; 12:e0186833. [PMID: 29088247 PMCID: PMC5663400 DOI: 10.1371/journal.pone.0186833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 10/09/2017] [Indexed: 12/03/2022] Open
Abstract
The objectives were to analyze the knowledge about overdose prevention, the use of naloxone, and the number of fatal overdoses after the implementation of Systematic Training in Overdose Prevention (STOOP) program. We conducted a quasi-experimental study, and held face-to-face interviews before (n = 725) and after (n = 722) implementation of systematic training in two different samples of people who injected opioids attending harm reduction centers. We asked participants to list the main causes of overdose and the main actions that should be taken when witnessing an overdose. We created two dependent variables, the number of (a) correct and (b) incorrect answers. The main independent variable was Study Group: Intervention Group (IG), Comparison Group (CG), Pre-Intervention Group With Sporadic Training in Overdose Prevention (PREIGS), or Pre-Intervention Group Without Training in Overdose Prevention (PREIGW). The relationship between the dependent and independent variables was assessed using a multivariate Poisson regression analysis. Finally, we conducted an interrupted time series analysis of monthly fatal overdoses before and after the implementation of systematic program during the period 2006–2015. Knowledge of overdose prevention increased after implementing systematic training program. Compared to the PREIGW, the IG gave more correct answers (IRR = 1.40;95%CI:1.33–1.47), and fewer incorrect answers (IRR = 0.33;95%CI:0.25–0.44). Forty percent of people who injected opioids who received a naloxone kit had used the kit in response to an overdose they witnessed. These courses increase knowledge of overdose prevention in people who use opioids, give them the necessary skills to use naloxone, and slightly diminish the number of fatal opioid overdoses in the city of Barcelona.
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Affiliation(s)
- Albert Espelt
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Spain
- Centros de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Calle Melchor Fernández Almagro, Madrid, Spain
- Facultat de Ciències de la Salut de Manresa, Universitat de Vic Universitat Central de Catalunya (UVicUCC), Av. Universitària, Manresa, Spain
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona, Campus UAB, Bellaterra, Spain
- * E-mail:
| | | | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Carretera Canyet s/n, Badalona, Spain
| | - Ana Sarasa-Renedo
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Spain
- Programa de Epidemiología Aplicada y de Campo (PEAC), Instituto de Salud Carlos III, Calle Sinesio Delgado, Madrid, Spain
| | - Xavier Majó
- Subdirecció General de Drogodependències, Departament de Salut de la Generalitat de Catalunya, Carrer de Roc Boronat, Barcelona, Spain
| | - Jordi Casabona
- Subdirecció General de Drogodependències, Departament de Salut de la Generalitat de Catalunya, Carrer de Roc Boronat, Barcelona, Spain
| | - M. Teresa Brugal
- Agència de Salut Pública de Barcelona, Plaça Lesseps, Barcelona, Spain
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