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Lapeyre-Mestre M. Addictovigilance in women, the hidden part of the iceberg? Therapie 2023; 78:157-164. [PMID: 36280399 DOI: 10.1016/j.therap.2022.10.006] [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: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 11/07/2022]
Abstract
Epidemiology of substance use disorders and their complications is driven by a male predominance, and women, even if they are more and more prevalent, are never specifically represented in studies in the field. Apart from the time of pregnancy, which in itself requires specific prevention, treatment and follow-up, the importance of the sex of women in the complications of substance abuse is neglected. To illustrate, we described some characteristics of women identified in the addictovigilance information system in France and Europe, related to drug use disorders (both for illicit substances and medications). Even if the exposure to some psychoactive substances remains more prevalent in men, women, and particularly young women, seem to be more vulnerable to the adverse effects of these substances, as observed for opioid analgesics, benzodiazepines, cannabis and even nitrous oxide. It is now imperative that the female sex/gender be taken into consideration in addictovigilance expertise and in drug safety in general, even for substances for which use is predominantly male. In addition, the adequate management of the women requires the development of specific prevention and care strategies.
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Affiliation(s)
- 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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2
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Jouanjus E, Gibaja V, Fabre F, Lapeyre-Mestre M. Medical prescription forms of opioid cough suppressants falsified by the patients before and after they switched from OTC to prescription-only in France. Br J Clin Pharmacol 2021; 88:1713-1721. [PMID: 34427950 DOI: 10.1111/bcp.15052] [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: 01/26/2021] [Revised: 06/07/2021] [Accepted: 07/09/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The French Ministry of Health scheduled opioid cough suppressants as prescription-only drugs on July 12th , 2017. The present study assessed the impact of this regulation on the diversion modalities of the concerned drugs and the related drug pholcodine by analysing the national OSIAP (Ordonnances suspectes indicateur d'abus possible) database. METHODS Medical prescriptions with at least one mention of codeine, dextromethorphan, ethylmorphine, noscapine or pholcodine for cough suppression recorded in 2013-2019 were extracted from OSIAP. Annual mentioning rates were estimated by dividing numbers of mentions over those of prescriptions recorded the year considered. A descriptive analysis compared the characteristics of prescriptions before and after July 12th , 2017. RESULTS Overall, 832 mentions of the requested drugs were retrieved on 827 prescription forms. Codeine was the most frequent (n=809, 8.7%) with 6 additional mentions of codeine/ethylmorphine combination, followed by dextromethorphan (n=11, 0.1%) and pholcodine (n=6, 0.1%). There was no mention of noscapine. Annual mentioning rates varied between 0 and 0.3% for all drugs except codeine. Codeine mentioning rates ranged between 0.3% (n=2) and 0.7% (n=9) before July 12th , 2017 and increased to 10.1% (n= 61) thereafter in 2017, 16.1% (n=314) in 2018, and 19.8% (n=414) in 2019. The profile of subjects evolved accordingly with an arisen male/female ratio (10.0 versus 1.5 before), a younger age (23 years versus 40 before, p<0.001). DISCUSSION The sharp increase of recourse to falsified prescription forms indicates that codeine diversion continues despite a restricted access, whereas the other drugs studied do not seem to have been impacted.
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Affiliation(s)
- Emilie Jouanjus
- Addictovigilance Centre, Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.,CERPOP, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Valérie Gibaja
- Addictovigilance Centre, Nancy University Hospital, Vandoeuvre les Nancy, France
| | - Florence Fabre
- Addictovigilance Centre, Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Addictovigilance Centre, Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
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Perelló M, Rio-Aige K, Guayta-Escolies R, Gascón P, Rius P, Jambrina AM, Bagaria G, Armelles M, Pérez-Cano FJ, Rabanal M. Evaluation of Medicine Abuse Trends in Community Pharmacies: The Medicine Abuse Observatory (MAO) in a Region of Southern Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7818. [PMID: 34360110 PMCID: PMC8345500 DOI: 10.3390/ijerph18157818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 01/23/2023]
Abstract
The misuse of medicines is a global public health concern that needs to be taken into consideration and requires actions across all government sectors and society. The aim of this study is to identify trends of drug abuse in Catalonia, a region of Spain located in the South of Europe. For this purpose, a questionnaire-based detection tool was created and implemented in 60 community pharmacies. Out of 548 questionnaires (98.4%), 64.2% of participants were men and the highest age proportion was 25-35 years (31.4%). Potential drug abuse was the highest in urban pharmacies (84.9%). The main drug class involved were benzodiazepines (31.8%), codeine (19.3%), tramadol (7.5%), methylphenidate (5.8%), gabapentinoids (5.8%), cycloplegic drops (4.4%), z-drugs (2.6%), piracetam (2.2%), dextromethorphan (1.6%) and clomethiazole (1.1%). The majority of drugs were requested without prescription (58.6%) and through probably forged prescriptions (23.7%). Slightly less than half (49.8%) of the patients request frequently to the pharmacist, especially in rural and mountain pharmacies (73.3% and 88.5%, respectively). A small proportion (10.8%) were requested with intimidation. Pharmacists only supplied in 21.7% of the cases. This study has demonstrated the suitability of the new detection system, being a useful approach to replicate in other locations with similar needs.
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Affiliation(s)
- Maria Perelló
- Barcelona College of Pharmacists, 08009 Barcelona, Spain; (M.P.); (G.B.)
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
| | - Karla Rio-Aige
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
- Institute of Research in Nutrition and Food Safety (INSA), 08921 Santa Coloma de Gramenet, Spain
| | - Rafel Guayta-Escolies
- Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (R.G.-E.); (P.G.)
| | - Pilar Gascón
- Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (R.G.-E.); (P.G.)
| | - Pilar Rius
- Council of the Pharmacist’s Association of Catalonia, 08009 Barcelona, Spain;
| | - Anna M. Jambrina
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain;
| | - Guillermo Bagaria
- Barcelona College of Pharmacists, 08009 Barcelona, Spain; (M.P.); (G.B.)
- Council of the Pharmacist’s Association of Catalonia, 08009 Barcelona, Spain;
| | - Mercè Armelles
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain;
| | - Francisco José Pérez-Cano
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
- Institute of Research in Nutrition and Food Safety (INSA), 08921 Santa Coloma de Gramenet, Spain
| | - Manel Rabanal
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
- Institute of Research in Nutrition and Food Safety (INSA), 08921 Santa Coloma de Gramenet, Spain
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain;
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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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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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Tambon M, Ponté C, Jouanjus E, Fouilhé N, Micallef J, Lapeyre-Mestre M. Gabapentinoid Abuse in France: Evidence on Health Consequences and New Points of Vigilance. Front Psychiatry 2021; 12:639780. [PMID: 33613345 PMCID: PMC7886797 DOI: 10.3389/fpsyt.2021.639780] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Gabapentinoid drugs (gabapentin and pregabalin) are widely used worldwide for epileptic and pain disorders. First signals of gabapentinoid abuse occurred in the last decade. This study aims to describe clinical characteristics of gabapentinoid use related disorders and health consequences in France. Materials and Methods: We designed a multisource investigation reviewing data reported to the French Addictovigilance Network (FAN) with pregabalin and gabapentin from 2010 to 2019. Information was obtained through the analysis of Spontaneous Reports (SRs) notified by health professionals and the pharmacoepidemiological surveys OSIAP (suspicious prescriptions forms indicators of potential abuse), OPPIDUM (observation of illicit drugs and misuse of psychotropic medications), DRAMES (death related to prescription drugs and other substances), and DTA (toxic deaths due to analgesics). Results: Over 2010-2019 period, were collected: (i) 265 SRs (258 pregabalin; 7 gabapentin); (ii) 816 forged prescription forms (805 pregabalin, 10 gabapentin, 1 involving both drugs); (iii) 145 cases of gabapentinoid use in people who use drugs (121 pregabalin; 24 gabapentin) and (iv) 31 cases of gabapentinoid-related deaths (25 pregabalin; 6 gabapentin). Risk factors of gabapentinoid abuse were opioid use disorders or psychiatric history, but cases of primary abuse in subjects without any substance abuse history were observed. Adverse outcomes concern almost exclusively pregabalin, with coma, dyspnea, convulsion, and conduction disorders. Treatment demands increased from 10.6% in 2018 to 23.1% in 2019, with pregabalin cited as the first substance leading to addictological care in the 2019 OPPIDUM survey. Gabapentinoid-related deaths increased over time. Pregabalin has become the first drug mentioned in forged prescriptions in 2019 (23.8% of OSIAP), while it ranked at the 15th position in 2017 (2.6%). Discussion: This study shows the importance of addictovigilance monitoring for gabapentinoids. Addictovigilance data helped to make visible the gabapentinoid-abuse related health harms (hospitalization for serious neurologic, psychiatric or cardiac effects, requests for addictological support and deaths) and to confirm the intrinsic abuse potential of pregabalin. These data highlight new points of vigilance considering observed primary abuse. At this point in France, the risk of abuse and related complications is very apparent with pregabalin. Still, it is identical to that observed elsewhere with gabapentin.
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Affiliation(s)
- Marine Tambon
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Camille Ponté
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Emilie Jouanjus
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France
| | - Nathalie Fouilhé
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie-Pharmacosurveillance, CHU Grenoble-Alpes, Grenoble, France
| | - Joelle Micallef
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France.,CEIP-Addictovigilance PACA Corse, Marseille, France
| | - Maryse Lapeyre-Mestre
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France.,Centre d'Investigation Clinique 1436, CHU de Toulouse, Toulouse, France
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7
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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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Touchard J, Sabatier P, Airagnes G, Berdot S, Sabatier B. Consequences of the new zolpidem prescription regulations: a cohort study from the French national healthcare database. Eur J Clin Pharmacol 2019; 76:89-95. [PMID: 31608425 DOI: 10.1007/s00228-019-02737-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/09/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine changes in the prevalence of zolpidem consumption since the change in the regulations of prescription. Formulations containing zolpidem were subject to the regulations of narcotics by the French decree of April 7, 2017. METHODS Longitudinal cohort study using data from the representative French healthcare database. The main outcome was the prevalence of oral hypnotic drug reimbursement before and after April 2017. The secondary outcome was the change in prescription habits for zolpidem since the decree in long-term users and excessive users. RESULTS A total of 81,174 individuals had at least one hypnotic drug reimbursement; among, whom 2143 had at least one reimbursement of zolpidem. Before the decree, 26% had at least one reimbursement of zolpidem, whereas it dropped to 18.4% after the decree. Among the 545 long-term users, the reimbursement of zolpidem was discontinued after the decree for 60.4% and 24.2% retained zolpidem as a treatment. The main replacement drug was zopiclone for 6.4% of them. Among the 1598 excessive users, the reimbursement of zolpidem was stopped after the decree for 16.5% and 56.3% retained zolpidem as a treatment. The main replacement drug was zopiclone for 12.1% of them. CONCLUSIONS The French decree had a major impact on the reimbursement of oral zolpidem. Indeed, prescription of the hypnotic was discontinued for half of the long-term users of zolpidem, and just over one-sixth of the excessive users discontinued the prescription of zolpidem after the decree.
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Affiliation(s)
- J Touchard
- Pharmacy Department, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - P Sabatier
- Equipe 22, UMR 1138 INSERM, Centre de Recherche des Cordeliers, Paris, France
| | - G Airagnes
- Department of Psychiatry and Addictology, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - S Berdot
- Pharmacy Department, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Equipe 22, UMR 1138 INSERM, Centre de Recherche des Cordeliers, Paris, France
- Faculty of Pharmacy, Clinical Pharmacy Department, Paris-Sud University, EA4123, Châtenay Malabry, France
| | - B Sabatier
- Pharmacy Department, Georges-Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Equipe 22, UMR 1138 INSERM, Centre de Recherche des Cordeliers, Paris, France
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9
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Sommet A, Pariente A. Methods in pharmacoepidemiology. Therapie 2019; 74:187-197. [PMID: 30819408 DOI: 10.1016/j.therap.2018.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/26/2018] [Indexed: 01/04/2023]
Abstract
Pharmacoepidemiology is the study of interactions between drugs and human populations, investigating, in real conditions of life, benefits, risks and use of drugs. Pharmacoepidemiology applies to drugs and their pharmacological evaluations, the different methods also used in epidemiology to assess in real conditions of life, benefits, risks and use of drugs. Pharmacoepidemiologic studies are ad-hoc studies or studies on databases. Specific methods exist to measure drug exposure, as well as indicators of compliance and misuse of drugs. Various designs for descriptive and explanatory studies exist, in a context in which a growing proportion of studies are carried out using medico-administrative data. The limits traditionally affecting the study designs are modified in this context, almost any design selected for the conduct of a study from these databases then deriving from a cohort in whom the information has been recorded prospectively and exhaustively.
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Affiliation(s)
- Agnès Sommet
- Service de pharmacologie médicale et clinique, UMR Inserm 1027, CIC Inserm 1436, faculté de médecine, centre hospitalier universitaire, 31000 Toulouse, France.
| | - Antoine Pariente
- Inserm, Bordeaux population health research centre, team pharmacoepidemiology, UMR 1219, university of Bordeaux, 33076 Bordeaux, France; Pôle de santé publique, centre régional de pharmacovigilance de Bordeaux, service de pharmacologie médicale, CHU de Bordeaux, 33076 Bordeaux, France
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10
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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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11
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Daveluy A, Sauvaget L, Bastien A, Lapeyre-Mestre M, Collin C, Richard N, Haramburu F. Tamper-resistant prescription forms for narcotics in France: Should we generalize them? Fundam Clin Pharmacol 2018; 32:571-577. [PMID: 29582450 DOI: 10.1111/fcp.12368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/27/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
In France, prescription of narcotics must be written on a tamper-resistant prescription form with specific technical particularities. Dosage and daily dose of medicines shall be written out entirely in letters. These prescription forms are also mandatory for buprenorphine, clorazepate, clonazepam, tianeptine, buccal midazolam and zolpidem owing to traffic, abuse or diversion. In 2012, to assess the use of standard and tamper-resistant prescription forms and the acceptability of the generalization of the latter to all medicines, a national opinion survey was performed, with a postal questionnaire, within three randomized samples of 1500 prescribers (physicians, dentists and midwives). Of the 403 participating prescribers (participation rate of 26.8%), 373 were physicians, 14 dentists and 16 midwives. Tamper-resistant prescription forms were used by 76.2% of prescribers, but only by 5.1% in a computerized version, whereas for standard prescription forms, 61% used computer assisted prescription software. The main reason was the inability of the prescription software to print these forms or to respect the mandatory prescription rules for narcotics. Theft and falsification of prescriptions had ever occurred (working life). Most prescribers (62.5%) were against the generalization of tamper-resistant prescription forms. Those in favour were for a generalization to all medicines (65%) and not only to psychotropic agents. Generalization of tamper-resistant prescription forms is not a consensual solution to prevent medicines' diversion. Some prescribers alluded to the possibility of dematerialization and electronic transmission of prescription forms, which could avoid theft, forgery or falsification.
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Affiliation(s)
- Amélie Daveluy
- Centre d'Addictovigilance, Service de Pharmacologie Médicale, CHU de Bordeaux, F-33000, Bordeaux, France.,Inserm U1219, Bordeaux Population Health, Equipe Pharmacoépidémiologie, F-33000, Bordeaux, France
| | - Lucie Sauvaget
- Centre d'Addictovigilance, Service de Pharmacologie Médicale, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Angela Bastien
- Centre d'Addictovigilance, Service de Pharmacologie Médicale, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale et Clinique, CIC Inserm 1436, CHU de Toulouse, 37 Allées Jules Guesde, F-31000, Toulouse, France
| | - Cédric Collin
- Agence Nationale de Sécurité du Médicament et des produits de santé, F-93285, Saint-Denis, France
| | - Nathalie Richard
- Agence Nationale de Sécurité du Médicament et des produits de santé, F-93285, Saint-Denis, France
| | - Françoise Haramburu
- Centre d'Addictovigilance, Service de Pharmacologie Médicale, CHU de Bordeaux, F-33000, Bordeaux, France.,Inserm U1219, Bordeaux Population Health, Equipe Pharmacoépidémiologie, F-33000, Bordeaux, France
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12
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Hulme S, Bright D, Nielsen S. The source and diversion of pharmaceutical drugs for non-medical use: A systematic review and meta-analysis. Drug Alcohol Depend 2018; 186:242-256. [PMID: 29626777 DOI: 10.1016/j.drugalcdep.2018.02.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The non-medical use (NMU) of pharmaceutical drugs is an increasing public health concern. This systematic review consolidates current knowledge about how pharmaceutical drugs are obtained for NMU and the processes and people involved in diversion. METHODS Peer-reviewed and grey literature databases were searched for empirical studies published between 1996 and 2017 that examined the source or diversion of pharmaceutical opioids, sedatives or stimulants for NMU in countries with reported misuse problems. Pooled prevalence meta-analyses using random effects models were used to estimate the prevalence of medical and non-medical sourcing reported by end-users, and gifting, selling and trading by various populations. RESULTS This review synthesizes the findings of 54 cross-sectional studies via meta-analyses, with a remaining 95 studies examined through narrative review. Pharmaceutical drugs are primarily sourced for NMU from friends and family (57%, 95% CI 53%-62%, I2 = 98.5, n = 30) and despite perceptions of healthcare professionals to the contrary, illegitimate practices such as doctor shopping are uncommon (7%, 95% CI 6%-10%, I2 = 97.4, n = 29). Those at risk of diversion include patients displaying aberrant medication behaviors, people with substance use issues and students in fraternity/sorority environments. Sourcing via dealers is also common (32%, 95% CI 23%-41%, I2 = 99.8, n = 25) and particularly so among people who use illicit drugs (47%, 95% CI 35%-60%, I2 = 99.1, n = 15). There is little to no organized criminal involvement in the pharmaceutical black market. CONCLUSION Pharmaceutical drugs for NMU are primarily sourced by end-users through social networks. Future research should examine how dealers source pharmaceutical drugs.
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Affiliation(s)
- Shann Hulme
- National Drug and Alcohol Research Centre, 22-32 King St, Randwick, NSW, 2031, Australia.
| | - David Bright
- School of Social Sciences, UNSW Australia, High Street, Kensington, NSW, 2052, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, 22-32 King St, Randwick, NSW, 2031, Australia
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13
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Jouanjus E, Guernec G, Lapeyre-Mestre M. Medical prescriptions falsified by the patients: a 12-year national monitoring to assess prescription drug diversion. Fundam Clin Pharmacol 2018; 32:306-322. [PMID: 29436015 DOI: 10.1111/fcp.12356] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/23/2018] [Accepted: 02/07/2018] [Indexed: 01/29/2023]
Abstract
Diversion of prescription drugs is difficult to assess in quality and quantity. This study aimed to characterize diversion of prescription drugs in France through a comparative analysis of falsified prescriptions collected during three periods from 2001 to 2012. The data recorded in a national program which records all falsified prescriptions presented to community pharmacies were studied. Included data regarded: subjects, prescription forms, and drugs. Description of the dataset in three periods (2001-2004, 2005-2008, and 2009-2012) was completed with clustering analyses to characterize profiles of prescriptions and subjects associated with the most reported drugs. The 4469 falsified prescriptions concerned most often females (51.6%). Average age was 46.5 years. Zolpidem, bromazepam, and buprenorphine were the most frequent drugs. Alone, 13 drugs (1.7%, 13/772) represented more than 40% of the total reports (3055/7272). They were associated with three diversion profiles: (i) buprenorphine, flunitrazepam, and morphine were mentioned on overlapping secure prescription forms presented by young men; (ii) alprazolam, bromazepam, zolpidem, codeine/acetaminophen were mentioned on simple prescription forms presented by experienced women; and (iii) acetaminophen and lorazepam were mentioned on modified prescription forms presented by elderly subjects. Clonazepam, clorazepate, dextropropoxyphene, zopiclone moved between those profiles. The patterns of falsified prescriptions provided in this study contribute to enhance the scientific knowledge on the most diverted prescription drugs. The latter follow distinct trajectories across time depending on their pharmacology (including their abuse/addiction potential) and on their regulation's history. The close and continuous analysis of falsified prescriptions is an excellent way to monitor prescription drug diversion.
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Affiliation(s)
- Emilie Jouanjus
- Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, 37, Allées Jules Guesde, 31000, Toulouse, France.,Department of Medical and Clinical Pharmacology, Addictovigilance Center, Toulouse University Hospital, 37, Allées Jules Guesde, 31000, Toulouse, France
| | - Grégory Guernec
- INSERM, UMR 1027, 37, Allées Jules Guesde, 31000, Toulouse, France.,UMR1027, University of Toulouse III, 31000, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, 37, Allées Jules Guesde, 31000, Toulouse, France.,Department of Medical and Clinical Pharmacology, Addictovigilance Center, Toulouse University Hospital, 37, Allées Jules Guesde, 31000, Toulouse, France
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14
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Waters L, Manchester KR, Maskell PD, Haegeman C, Haider S. The use of a quantitative structure-activity relationship (QSAR) model to predict GABA-A receptor binding of newly emerging benzodiazepines. Sci Justice 2017; 58:219-225. [PMID: 29685303 DOI: 10.1016/j.scijus.2017.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/13/2017] [Accepted: 12/16/2017] [Indexed: 02/06/2023]
Abstract
The illicit market for new psychoactive substances is forever expanding. Benzodiazepines and their derivatives are one of a number of groups of these substances and thus far their number has grown year upon year. For both forensic and clinical purposes it is important to be able to rapidly understand these emerging substances. However as a consequence of the illicit nature of these compounds, there is a deficiency in the pharmacological data available for these 'new' benzodiazepines. In order to further understand the pharmacology of 'new' benzodiazepines we utilised a quantitative structure-activity relationship (QSAR) approach. A set of 69 benzodiazepine-based compounds was analysed to develop a QSAR training set with respect to published binding values to GABAA receptors. The QSAR model returned an R2 value of 0.90. The most influential factors were found to be the positioning of two H-bond acceptors, two aromatic rings and a hydrophobic group. A test set of nine random compounds was then selected for internal validation to determine the predictive ability of the model and gave an R2 value of 0.86 when comparing the binding values with their experimental data. The QSAR model was then used to predict the binding for 22 benzodiazepines that are classed as new psychoactive substances. This model will allow rapid prediction of the binding activity of emerging benzodiazepines in a rapid and economic way, compared with lengthy and expensive in vitro/in vivo analysis. This will enable forensic chemists and toxicologists to better understand both recently developed compounds and prediction of substances likely to emerge in the future.
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Affiliation(s)
- Laura Waters
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK.
| | | | - Peter D Maskell
- School of Science, Engineering and Technology, Abertay University, Dundee, UK
| | | | - Shozeb Haider
- School of Pharmacy, University College London, London, UK
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15
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Frauger E, Pochard L, Boucherie Q, Giocanti A, Chevallier C, Daveluy A, Gibaja V, Caous AS, Eiden C, Authier N, Le Boisselier R, Guerlais M, Jouanjus É, Lepelley M, Pizzoglio V, Pain S, Richard N, Micallef J. Dispositif pharmacoépidémiologique de surveillance des substances psychoactives : intérêts du programme national OPPIDUM du Réseau français d’addictovigilance. Therapie 2017; 72:491-501. [DOI: 10.1016/j.therap.2017.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/16/2017] [Accepted: 02/14/2017] [Indexed: 11/30/2022]
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16
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Ponté C, Pi C, Palmaro A, Jouanjus E, Lapeyre‐Mestre M. Early signal of diverted use of tropicamide eye drops in France. Br J Clin Pharmacol 2017; 83:1791-1800. [PMID: 28239898 PMCID: PMC5510080 DOI: 10.1111/bcp.13272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/31/2017] [Accepted: 02/18/2017] [Indexed: 01/16/2023] Open
Abstract
AIMS Tropicamide is a mydriatic drug used as eye-drops for diagnostic or therapeutic purposes. From 2013, a diverted use by intravenous route has been suspected in Eastern Europe in opioids users. To date, no signal of misuse has been identified in France. The aims of this study were to investigate any early signals of a diverted use of tropicamide eye drops and to collect information regarding motives for the misuse and tropicamide-induced effects. METHODS Information was obtained at three levels: (1) at regional level (Midi-Pyrénées area), from reimbursement data and pharmacists' reports on suspicious requests; (2) at national level: from reimbursement data and prescriptions suggesting possible abuse from the OSIAP (Ordonnances Suspectes, Indicateur d'Abus Possible) survey; and (3) at international level: from VigiBase® reports and Web sources. Beta-blocker eye-drops were used as comparators. RESULTS In France, in 2014-2015, 17 (0.91%, 95% CI [0.53-1.46%]) falsified prescriptions involving tropicamide were identified in the OSIAP survey (compared with 0%, 95% CI [0-0.19%] for beta-blockers). Moreover, 37 other suspicious prescriptions were presented in 2015 (notified in 2016). In Midi-Pyrénées, seven patients aged 35-49 were reimbursed for 19-45 vials of 10 ml, in a year. Since September 2014, the regional Addictovigilance Centre has received 91 notifications of suspicious requests to obtain tropicamide. In VigiBase® , two cases were identified but none in France. An increased interest in tropicamide-related Internet searches was observed from Russia and Ukraine. CONCLUSIONS These results represent the first early warnings of a tropicamide diverted use in France. Tropicamide abusers would seek euphoria or hallucinations. The high doses involved in intravenous administration could lead to serious complications.
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Affiliation(s)
- Camille Ponté
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
| | - Christian Pi
- Direction de la Santé Publique, Pôle Alertes, Risques et VigilancesARS Languedoc‐Roussillon‐Midi‐Pyrénées26–28 Parc club du Millénaire, 1 025, rue Henri BecquerelCS30001, 34067Montpellier Cedex 2France
| | - Aurore Palmaro
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
- Service de Pharmacologie Médicale et CliniqueCHU ToulouseToulouseFrance
| | - Emilie Jouanjus
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
| | - Maryse Lapeyre‐Mestre
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
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17
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Rolland B, Bouhassira D, Authier N, Auriacombe M, Martinez V, Polomeni P, Brousse G, Schwan R, Lack P, Bachellier J, Rostaing S, Bendimerad P, Vergne-Salle P, Dematteis M, Perrot S. [Misuse and dependence on prescription opioids: Prevention, identification and treatment]. Rev Med Interne 2017; 38:539-546. [PMID: 28214183 DOI: 10.1016/j.revmed.2016.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/23/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022]
Abstract
Since the 1990s, the use of prescription opioids has largely spread, which has brought a real progress in the treatment of pain. The long-term use of prescription opioid is sometimes required, and may lead to pharmacological tolerance and withdrawal symptoms, i.e. pharmacological dependence on prescription opioids. Occasionally, this may also lead to misuse of prescription opioids (MPO). MPO preferentially occurs in vulnerable individuals, i.e., those with a young age, history of other addictive or psychiatric disorders, especially anxious and depressive disorders. MPO is associated with numerous complications, including an increased risk of fatal overdose. Prevention of MPO begins before the opioid prescription, with the identification of potential vulnerability factors. A planned and personalized monitoring should be systematically implemented. In vulnerable patients, contractualizing the prescription is warranted. During follow-up, the relevance of the prescription should be regularly reconsidered, according to the benefit observed on pain and the potential underlying signs of MPO. Patients with suspected MPO should be referred early to pain or addiction centers. The treatment of MPO should be based on multidisciplinary strategies, involving both the addiction and pain aspects: progressive opioid withdrawal, non-pharmacological measures against pain, or switching to medication-assisted treatment of addiction (i.e., buprenorphine or methadone).
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Affiliation(s)
- B Rolland
- Service d'addictologie, hôpital Fontan 2, CHRU de Lille, CS 70001, 59037 Lille cedex, France.
| | - D Bouhassira
- Inserm U-987, centre d'évaluation et de traitement de la douleur, hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France
| | - N Authier
- UMR Inserm 1107, faculté de médecine, pharmacologie médicale, CRPV/CEIP/CETD, centre d'évaluation et de traitement de la douleur/institut Analgesia, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - M Auriacombe
- Université de Bordeaux et CNRS USR 3413 (sanpsy), pôle addictologie, CH Ch. Perrens et CHU de Bordeaux, 33076 Bordeaux, France
| | - V Martinez
- Service d'anesthésie, hôpital Raymond-Poincaré, 92380 Garches, France
| | - P Polomeni
- Service d'addictologie, hôpital René-Muret, hôpitaux universitaires Paris Seine-Saint-Denis, 93270 Sevran, France
| | - G Brousse
- Service de psychiatrie B, CHU, hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France
| | - R Schwan
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Nancy, centre psychothérapique de Nancy, 54520 Laxou, France
| | - P Lack
- CSAPA, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - J Bachellier
- CSAPA centre Port-Bretagne, CHU de Tours, 37000 Tours, France
| | - S Rostaing
- Hôpital Saint-Antoine, centre d'évaluation et de traitement de la douleur, 75012 Paris, France
| | - P Bendimerad
- Service de psychiatrie, secteur 2, CH de La Rochelle, 17019 La Rochelle, France
| | - P Vergne-Salle
- Service de rhumatologie et centre de la douleur, CHU de Limoges, 87042 Limoges, France
| | - M Dematteis
- Service d'addictologie, CHU de Grenoble-Alpes, université Grenoble-Alpes, 38700 La Tronche, France
| | - S Perrot
- Inserm U-987, centre de la douleur, hôpital Hôtel-Dieu, université Paris-Descartes, 75014 Paris, France
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18
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Victorri-Vigneau C, Hardouin JB, Rousselet M, Gerardin M, Guerlais M, Guillou M, Bronnec M, Sébille V, Jolliet P. Multicentre study for validation of the French addictovigilance network reports assessment tool. Br J Clin Pharmacol 2016; 82:1030-9. [PMID: 27302554 DOI: 10.1111/bcp.13044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/27/2022] Open
Abstract
AIMS The French health authority (ANSM) is responsible for monitoring medicinal and other drug dependencies. To support these activities, the ANSM manages a network of 13 drug dependence evaluation and information centres (Centres d'Evaluation et d'Information sur la Pharmacodépendance - Addictovigilance - CEIP-A) throughout France. In 2006, the Nantes CEIP-A created a new tool called the EGAP (Echelle de GrAvité de la Pharmacodépendance- drug dependence severity scale) based on DSM IV criteria. This tool allows the creation of a substance use profile that enables the drug dependence severity to be homogeneously quantified by assigning a score to each substance indicated in the reports from health professionals. This article describes the validation and psychometric properties of the drug dependence severity score obtained from the scale ( Clinicaltrials.gov NCT01052675). METHOD The validity of the EGAP construct, the concurrent validity and the discriminative ability of the EGAP score, the consistency of answers to EGAP items, the internal consistency and inter rater reliability of the EGAP score were assessed using statistical methods that are generally used for psychometric tests. RESULTS The total EGAP score was a reliable and precise measure for evaluating drug dependence (Cronbach alpha = 0.84; ASI correlation = 0.70; global ICC = 0.92). In addition to its good psychometric properties, the EGAP is a simple and efficient tool that can be easily specified on the official ANSM notification form. CONCLUSION The good psychometric properties of the total EGAP score justify its use for evaluating the severity of drug dependence.
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Affiliation(s)
- Caroline Victorri-Vigneau
- Pharmacology Department, Nantes University Hospital, Institute of Biology, Hôtel Dieu, 9, Quai Moncousu, 44093, Nantes Cedex 01, France. .,EA 4275 Biostatistics, Pharmacoepidemiology and Subjective Measures in Health, UFR Pharmaceutical Sciences, 1 rue Gaston Veil, BP 53508, 44035, Nantes cedex 1, France.
| | - Jean Benoit Hardouin
- EA 4275 Biostatistics, Pharmacoepidemiology and Subjective Measures in Health, UFR Pharmaceutical Sciences, 1 rue Gaston Veil, BP 53508, 44035, Nantes cedex 1, France
| | - Morgane Rousselet
- Pharmacology Department, Nantes University Hospital, Institute of Biology, Hôtel Dieu, 9, Quai Moncousu, 44093, Nantes Cedex 01, France.,EA 4275 Biostatistics, Pharmacoepidemiology and Subjective Measures in Health, UFR Pharmaceutical Sciences, 1 rue Gaston Veil, BP 53508, 44035, Nantes cedex 1, France.,Addictology Department, Nantes University Hospital, Bâtiment Louis Philippe, Hôpital St Jacques, 85 rue Saint-Jacques, 44093, Nantes Cedex 1, France
| | - Marie Gerardin
- Pharmacology Department, Nantes University Hospital, Institute of Biology, Hôtel Dieu, 9, Quai Moncousu, 44093, Nantes Cedex 01, France.,EA 4275 Biostatistics, Pharmacoepidemiology and Subjective Measures in Health, UFR Pharmaceutical Sciences, 1 rue Gaston Veil, BP 53508, 44035, Nantes cedex 1, France
| | - Marylène Guerlais
- Pharmacology Department, Nantes University Hospital, Institute of Biology, Hôtel Dieu, 9, Quai Moncousu, 44093, Nantes Cedex 01, France
| | - Morgane Guillou
- Addictology Department, Nantes University Hospital, Bâtiment Louis Philippe, Hôpital St Jacques, 85 rue Saint-Jacques, 44093, Nantes Cedex 1, France
| | - Marie Bronnec
- EA 4275 Biostatistics, Pharmacoepidemiology and Subjective Measures in Health, UFR Pharmaceutical Sciences, 1 rue Gaston Veil, BP 53508, 44035, Nantes cedex 1, France.,Addictology Department, Nantes University Hospital, Bâtiment Louis Philippe, Hôpital St Jacques, 85 rue Saint-Jacques, 44093, Nantes Cedex 1, France
| | - Véronique Sébille
- EA 4275 Biostatistics, Pharmacoepidemiology and Subjective Measures in Health, UFR Pharmaceutical Sciences, 1 rue Gaston Veil, BP 53508, 44035, Nantes cedex 1, France
| | - Pascale Jolliet
- Pharmacology Department, Nantes University Hospital, Institute of Biology, Hôtel Dieu, 9, Quai Moncousu, 44093, Nantes Cedex 01, France.,EA 4275 Biostatistics, Pharmacoepidemiology and Subjective Measures in Health, UFR Pharmaceutical Sciences, 1 rue Gaston Veil, BP 53508, 44035, Nantes cedex 1, France
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Hoffmann F, Glaeske G. [Benzodiazepine hypnotics, zolpidem and zopiclone on private prescriptions: use between 1993 and 2012]. DER NERVENARZT 2015; 85:1402-9. [PMID: 24663439 DOI: 10.1007/s00115-014-4016-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Previous analyses showed that benzodiazepine hypnotics as well as zolpidem and zopiclone (Z drugs) were increasingly being dispensed on so-called private prescriptions (Privatverordnungen) in Germany. Any doctor can provide private prescriptions for prescription drugs which are fully funded by the patient. This study aimed to analyze the amount of private prescriptions for hypnotics over the last 20 years. METHODS We compared utilization data from statutory health insurance claims with purchasing statistics from community pharmacies for the years 1993-2012. RESULTS From 1993 to 2012 purchased packages of hypnotics decreased (from 14.9 to 9.9 million). Benzodiazepines were dispensed less and Z drugs more often. In 2012 zopiclone (4.3 million packages of which 42.7 % were private prescriptions), zolpidem (3.6 million, 57.6 %) and lormetazepam (0.8 million, 57.8 %) were most often prescribed. CONCLUSION Trends in prescribing Z drugs are particularly noticeable whereby zolpidem was dispensed more often on private prescriptions than zopiclone. This seems to be further evidence for a higher dependence and abuse potential of zolpidem.
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Affiliation(s)
- F Hoffmann
- ZeS, Abteilung Gesundheitsökonomie, Gesundheitspolitik und Versorgungsforschung, Universität Bremen, 28334, Bremen, Deutschland,
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Roussin A, Doazan-d'Ouince O, Géniaux H, Halberer C. Evaluation of abuse and dependence in addiction monitoring systems: tramadol as an example. Therapie 2015; 70:203-21. [PMID: 25858577 DOI: 10.2515/therapie/2015014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/21/2014] [Indexed: 11/20/2022]
Abstract
The objective of this paper is to present an evaluation of the potential for abuse of and dependence on a drug from the data obtained from the different pharmacoepidemiological tools used by the French network for evaluation and information on pharmacodependence and addiction monitoring taking the example of tramadol. Comparison of the data from spontaneous reports with surveys in specific populations and with evaluations of indicators of diverted uses does not highlight a major problem of tramadol abuse and dependence in terms of public health, but stresses the importance of paying attention to the signal. This example of addiction monitoring of tramadol illustrates the interest of comparing results obtained from different validated sources. The implementation of repeated observational programs of abuse of and dependence on psychoactive drugs is an important aid to health authorities to define the content of the information to be delivered or regulatory decisions to reduce these problematic uses.
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Affiliation(s)
- Anne Roussin
- Centre d'Évaluation et d'Information sur la Pharmacodépendance (Centre d'Addictovigilance), Service de Pharmacologie Clinique, Hôpitaux de Toulouse, Toulouse, France - Pharmacoépidémiologie, UMR1027 INSERM - Université de Toulouse III, Toulouse, France
| | - Odile Doazan-d'Ouince
- Pharmacoépidémiologie, UMR1027 INSERM - Université de Toulouse III, Toulouse, France
| | - Hélène Géniaux
- Centre d'Évaluation et d'Information sur la Pharmacodépendance (Centre d'Addictovigilance), Département de Pharmacologie, CHU de Bordeaux, Bordeaux, France
| | - Clémence Halberer
- Pharmacoépidémiologie, UMR1027 INSERM - Université de Toulouse III, Toulouse, France
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Jouanjus E, Gibaja V, Kahn JP, Haramburu F, Daveluy A. Signal identification in addictovigilance: the functioning of the French system. Therapie 2015; 70:113-31. [PMID: 25858567 DOI: 10.2515/therapie/2015011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/23/2014] [Indexed: 11/20/2022]
Abstract
The French addictovigilance network (addictovigilance: surveillance of addiction), composed of 13 Addictovigilance Centres, was set up in 1990 in order to achieve reliable surveillance and evaluation of abuse and dependence cases due to psychoactive substances (alcohol and tobacco excepted). The detection of safety signals is one of the roles of the addictovigilance centres. Signals from spontaneous reports need to be analyzed before further communication. In addictovigilance, signals may be linked to adverse effects (deaths, pathological signs), to products (new psychoactive substances with potentially dangerous effects) or to practices (new administration routes, new contexts of use). These signals are provided by numerous partners among whom the addictovigilance network has to raise awareness about information that may possibly be an alert signal. The watchful attitude of all partners will make it possible that signals will be, after analyze, considered as true alerts. The addictovigilance network collects data, assess the potential for addiction of psychoactive drugs to provide information on the risk of addiction and give opinions for public health decisions (harm reduction or prevention programs, psychoactive substances control, health alerts).
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Affiliation(s)
- Emilie Jouanjus
- Centre d'Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU, Faculté de Médecine, Toulouse, France
| | - Valérie Gibaja
- Centre d'Addictovigilance, Hôpital Central, CHU de Nancy, Nancy, France
| | - Jean-Pierre Kahn
- Centre d'Addictovigilance, Hôpital Central, CHU de Nancy, Nancy, France - Service de Psychiatrie et Psychologie Clinique, Unité 6, Centre Psychothérapique de Nancy, Université de Lorraine, Laxou, France - Faculté de Médecine, Université Henri Poincaré Nancy 1, Nancy, France
| | - Françoise Haramburu
- Centre d'Addictovigilance, Service de Pharmacologie Médicale, CHU de Bordeaux, INSERM U657, Bordeaux, France
| | - Amélie Daveluy
- Centre d'Addictovigilance, Service de Pharmacologie Médicale, CHU de Bordeaux, INSERM U657, Bordeaux, France
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Jouanjus E, Gibaja V, Kahn JP, Haramburu F, Daveluy A. Comment identifier un signal en addictovigilance ? Therapie 2015. [DOI: 10.2515/therapie/2015009] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Roussin A, d’Ouince OD, Géniaux H, Halberer C. Un exemple d’évaluation de l’abus et de la dépendance en addictovigilance : à propos du tramadol. Therapie 2015. [DOI: 10.2515/therapie/2014221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Frauger E, Moracchini C, Albertini F, Thirion X, Micallef J. French Specific Surveillance System for Drug Abuse. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.1080/00207411.2014.1003741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Victorri-Vigneau C, Gérardin M, Rousselet M, Guerlais M, Grall-Bronnec M, Jolliet P. An Update on Zolpidem Abuse and Dependence. J Addict Dis 2014; 33:15-23. [PMID: 24467433 DOI: 10.1080/10550887.2014.882725] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Lapeyre-Mestre M, Gony M, Carvajal A, Macias D, Conforti A, D'Incau P, Heerdink R, Van der Stichele R, Bergman U. A European community pharmacy-based survey to investigate patterns of prescription fraud through identification of falsified prescriptions. Eur Addict Res 2014; 20:174-82. [PMID: 24458222 DOI: 10.1159/000356812] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022]
Abstract
AIM To identify prescription drugs involved in falsified prescriptions in community pharmacies in 6 European countries. METHODS A cross-sectional survey among 2,105 community pharmacies in Belgium, France, Italy, the Netherlands, Spain and Sweden was carried out to collect all suspect prescription forms. For each reported drug, the number of reported falsified prescriptions per thousand inhabitants was estimated. A falsification ratio was calculated by dividing the number of reports by the number of defined daily doses per 1,000 inhabitants per day for this drug, computed from national sale or reimbursement data. RESULTS On 862 prescription forms, benzodiazepines (zolpidem, bromazepam, alprazolam), buprenorphine (as an opioid maintenance drug) and tramadol were the most frequently reported. Depending on their level of use in each country, methylphenidate, morphine and flunitrazepam presented the highest falsification ratios, particularly in Spain, Belgium and France. CONCLUSIONS Stimulants, opioids and some benzodiazepines were the most frequently reported drugs in this survey on falsified prescriptions, but differences between countries were observed.
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Affiliation(s)
- Maryse Lapeyre-Mestre
- University of Toulouse UMR INSERM 1027, CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU, Toulouse, France
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Frauger E, Moracchini C, Le Boisselier R, Braunstein D, Thirion X, Micallef J. OPPIDUM surveillance program: 20 years of information on drug abuse in France. Fundam Clin Pharmacol 2013; 27:672-82. [PMID: 23510229 DOI: 10.1111/fcp.12024] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 02/07/2013] [Accepted: 02/11/2013] [Indexed: 11/29/2022]
Abstract
It is important to assess drug abuse liability in 'real life' using different surveillance systems. Some are based on specific population surveys, such as individuals with drug abuse or dependence, or under opiate maintenance treatment, because this population is very familiar with drugs and is more likely to divert or abuse them. In France, an original surveillance system based on this specific population and called 'Observation of illegal drugs and misuse of psychotropic medications (OPPIDUM) survey' was set up in 1990 as the first of its kind. The aim of this article is to describe this precursor of French drug abuse surveillance using different examples, to demonstrate its ability to effectively give health authorities and physicians interesting data on drug abuse. OPPIDUM is an annual, cross-sectional survey that anonymously collects information on abuse and dependence observed in patients recruited in specialized care centers dedicated to drug dependence. From 1990 to 2010, a total of 50,734 patients were included with descriptions of 102,631 psychoactive substance consumptions. These data have outlined emergent behaviors such as the misuse of buprenorphine by intravenous or nasal administration. It has contributed to assess abuse liability of emergent drugs such as clonazepam or methylphenidate. This surveillance system was also able to detect the decrease of flunitrazepam abuse following implementation of regulatory measures. OPPIDUM's twenty years of experience clearly demonstrate that collection of valid and useful data on drug abuse is possible and can provide helpful information for physicians and health authorities.
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Affiliation(s)
- Elisabeth Frauger
- Centre d'Evaluation et d'Information sur la Pharmacodépendance Paca Corse, Service de Pharmacologie Médicale et Clinique, Hôpital de la Timone, 13005, Marseille; Aix Marseille Université, Institut des Neurosciences Timone - UMR 7289 CNRS, 13005 Marseille, France
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Singh N, Fishman S, Rich B, Orlowski A. Prescription Opioid Forgery: Reporting to Law Enforcement and Protection of Medical Information. PAIN MEDICINE 2013; 14:792-8. [PMID: 23461809 DOI: 10.1111/pme.12062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Naileshni Singh
- Department of Anesthesiology and Pain Medicine; University of California, Davis; Sacramento; California
| | - Scott Fishman
- Department of Anesthesiology and Pain Medicine; University of California, Davis; Sacramento; California
| | - Ben Rich
- Department of Bioethics and Anesthesiology and Pain Medicine; University of California, Davis; Sacramento; California
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Peyriere H, Eiden C, Micallef J, Lapeyre-Mestre M, Faillie JL, Blayac JP. Slow-release oral morphine sulfate abuse: results of the postmarketing surveillance systems for psychoactive prescription drug abuse in France. Eur Addict Res 2013; 19:235-44. [PMID: 23428846 DOI: 10.1159/000346179] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few data are available concerning the diversion and abuse of morphine sulfate. In France, morphine sulfate abuse is currently investigated by the health authorities. The aim of our study was to provide data on morphine sulfate abuse in France, collected during the period 1996-2011. METHODS The French monitoring system for psychoactive medication abuse collected data from several sources: spontaneous reporting of cases of abuse or dependence (NotS; 'Notifications Spontanées'), specific periodic surveys from specialized care centers (OPPIDUM; 'Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse'), and community pharmacists (OSIAP; 'Ordonnances Suspectes Indicateur d'Abus Possible'). RESULTS A total of 649 cases (75% men, median age: 34 years) were spontaneously reported: 578 cases of abuse and 71 cases of use as opiate maintenance treatment. The medication formulation was Skenan(®) (614 cases), and Moscontin(®) (35 cases). All surveys (NotS, OPPIDUM, and OSIAP) showed an overrepresentation of Skenan(®) (87.9-94.6% of cases) that was intravenously injected in 60.4-61.2% of the cases. Data analysis showed that patients abusing morphine sulfate have a long history of drug abuse and a history of polydrug use. CONCLUSION All the data presented in this study highlight the level of morphine sulfate abuse, specify the modalities of use (intravenous route), and show the risks associated with abuse (infectious diseases). This study outlines the usefulness of our epidemiological tools, and provides evidence supporting intensive surveillance.
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Affiliation(s)
- Hélène Peyriere
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Hôpital Lapeyronie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
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30
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Lapeyre-Mestre M. Addiction médicamenteuse : quelles données pour évaluer et prévenir ? ACTA ACUST UNITED AC 2013. [DOI: 10.3917/psyt.191.0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Pauly V, Pradel V, Pourcel L, Nordmann S, Frauger E, Lapeyre-Mestre M, Micallef J, Thirion X. Estimated magnitude of diversion and abuse of opioids relative to benzodiazepines in France. Drug Alcohol Depend 2012; 126:13-20. [PMID: 22475815 DOI: 10.1016/j.drugalcdep.2012.03.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 03/07/2012] [Accepted: 03/10/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Prescription drug abuse is a major concern in several countries. France appears to be particularly prone to the abuse of opiate maintenance treatment (OMT) opioids and benzodiazepines (BZD), whereas the abuse of opioid analgesics (OA) is less commonly reported. To estimate the extent of psychoactive drug abuse, the French drug agency relies on different methods measuring various diversion indicators used as proxies for the detection of abuse/misuse: suspicion of abuse/dependence, illegal acquisition by patients seen in specialized care centers, prescription forgery and doctor shopping. The main objectives of the present study are to analyse the abuse and diversion of opioids (both OA and OMT), in comparison with those of BZDs, through the concurrent use of three different data sources. METHODS Diversion and abuse of opioids were analysed using indicators of abuse and diversion derived from three data sources over the period 2006-2008. Then, opioids were compared to BZDs for the year 2008 using the same indicators. RESULTS The analysis suggests that BZDs are more commonly dispensed than OAs and OMTs but that abuse and diversion are related mainly to OMT (particularly to buprenorphine), morphine and BZDs and less to OAs (except for morphine). CONCLUSION This study presents an original approach, based on the use of multiple data sources, to evaluate and compare the estimated abuse and diversion of opioids and benzodiazepines. It provides health authorities with a global, comparative and summarized overall view of the importance of different patterns of diversion and abuse for different prescription drugs.
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Affiliation(s)
- V Pauly
- Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A) de Marseille (PACA-Corse)-Centre Associé. Laboratoire de Santé Publique, Faculté de médecine EA 3279, 37 Bd Jean Moulin, 13005 Marseille, France
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Daveluy A, Miremont-Salamé G, Kostrzewa A, Couret A, Lacoin L, Lecomte C, Moore N, Gilleron V, Haramburu F. Identification of abuse and dependence cases through a hospital database. Pharmacoepidemiol Drug Saf 2012; 21:1344-9. [DOI: 10.1002/pds.3369] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 10/01/2012] [Accepted: 10/08/2012] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - A Kostrzewa
- CHU de Bordeaux; Service d'information médicale; F-33000; Bordeaux; France
| | - A Couret
- CHU de Bordeaux; Service de Pharmacologie, Centre d'évaluation et d'information sur la Pharmacodépendance-Addictovigilance; F-33000; Bordeaux; France
| | - L Lacoin
- CHU de Bordeaux; Service de Pharmacologie, Centre d'évaluation et d'information sur la Pharmacodépendance-Addictovigilance; F-33000; Bordeaux; France
| | - C Lecomte
- CHU de Bordeaux; Service de Pharmacologie, Centre d'évaluation et d'information sur la Pharmacodépendance-Addictovigilance; F-33000; Bordeaux; France
| | | | - V Gilleron
- CHU de Bordeaux; Service d'information médicale; F-33000; Bordeaux; France
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Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend 2012; 125:8-18. [PMID: 22857878 PMCID: PMC3454351 DOI: 10.1016/j.drugalcdep.2012.07.004] [Citation(s) in RCA: 461] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 07/08/2012] [Accepted: 07/09/2012] [Indexed: 12/26/2022]
Abstract
This paper reviews studies examining the pharmacological interactions and epidemiology of the combined use of opioids and benzodiazepines (BZDs). A search of English language publications from 1970 to 2012 was conducted using PubMed and PsycINFO(®). Our search found approximately 200 articles appropriate for inclusion in this paper. While numerous reports indicate that the co-abuse of opioids and BZDs is ubiquitous around the world, the reasons for the co-abuse of these medications are not entirely clear. Though the possibility remains that opioid abusers are using BZDs therapeutically to self-medicate anxiety, mania or insomnia, the data reviewed in this paper suggest that BZD use is primarily recreational. For example, co-users report seeking BZD prescriptions for the purpose of enhancing opioid intoxication or "high," and use doses that exceed the therapeutic range. Since there are few clinical studies investigating the pharmacological interaction and abuse liability of their combined use, this hypothesis has not been extensively evaluated in clinical settings. As such, our analysis encourages further systematic investigation of BZD abuse among opioid abusers. The co-abuse of BZDs and opioids is substantial and has negative consequences for general health, overdose lethality, and treatment outcome. Physicians should address this important and underappreciated problem with more cautious prescribing practices, and increased vigilance for abusive patterns of use.
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Affiliation(s)
- Jermaine D. Jones
- Division on Substance Abuse, New York Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Shanthi Mogali
- Division on Substance Abuse, New York Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
| | - Sandra D. Comer
- Division on Substance Abuse, New York Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA
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Moracchini C, Frauger E, Pauly V, Nordmann S, Thirion X, Micallef J. Les CAARUD, lieux privilégiés d’émergence de signaux pour l’addictovigilance. Therapie 2012; 67:437-45. [DOI: 10.2515/therapie/2012064] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/04/2012] [Indexed: 11/20/2022]
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Moracchini C, Orleans V, Miloudi S, Frauger E, Micallef J, Thirion X. Observation des pharmacodépendances en médecine ambulatoire : le programme OPEMA. Therapie 2012; 67:397-404. [DOI: 10.2515/therapie/2012037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/29/2012] [Indexed: 11/20/2022]
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Corsenac P, Lagarde E, Gadegbeku B, Delorme B, Tricotel A, Castot A, Moore N, Philip P, Laumon B, Orriols L. Road traffic crashes and prescribed methadone and buprenorphine: a French registry-based case-control study. Drug Alcohol Depend 2012; 123:91-7. [PMID: 22104480 DOI: 10.1016/j.drugalcdep.2011.10.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 10/17/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Opioids have been shown to impair psychomotor and cognitive functioning in healthy volunteers with no history of opioid abuse. Few or no significant effects have been found in opioid-dependant patients in experimental or driving simulation studies. The risk of road traffic crash among patients under buprenorphine or methadone has not been subject to epidemiological investigation so far. The objective was to investigate the association between the risk of being responsible for a road traffic crash and the use of buprenorphine and methadone. METHODS Data from three French national databases were extracted and matched: the national health care insurance database, police reports, and the national police database of injurious crashes. Case-control analysis comparing responsible versus non responsible drivers was conducted. RESULTS 72,685 drivers involved in an injurious crash in France over the July 2005-May 2008 period, were identified by their national health care number. The 196 drivers exposed to buprenorphine or methadone on the day of crash were young, essentially males, with an important co-consumption of other substances (alcohol and benzodiazepines). Injured drivers exposed to buprenorphine or methadone on the day of crash, had an increased risk of being responsible for the crash (odds ratio (OR)=2.02, 95% confidence interval (CI): 1.40 and 2.91). CONCLUSIONS Users of methadone and buprenorphine were at increased risk of being responsible for injurious road traffic crashes. The increased risk could be explained by the combined effect of risky behaviors and treatments.
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Affiliation(s)
- Philippe Corsenac
- Equipe Prévention et prise en charge des traumatismes, Centre de recherche INSERM U897 Epidémiologie et Biostatistiques, Institut de Santé Publique d'Epidémiologie et de Développement, Université Bordeaux Segalen, Case 11, 146 rue Léo Saignat, 33 076 Bordeaux cedex, France
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Jouanjus E, Pourcel L, Saivin S, Molinier L, Lapeyre-Mestre M. Use of multiple sources and capture-recapture method to estimate the frequency of hospitalizations related to drug abuse. Pharmacoepidemiol Drug Saf 2012; 21:733-741. [DOI: 10.1002/pds.3280] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/13/2012] [Accepted: 03/16/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Emilie Jouanjus
- Equipe de Pharmacoépidémiologie; Inserm, UMR1027; Toulouse France
- Université de Toulouse III, UMR1027; Toulouse France
- Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance; Centre Hospitalier Universitaire; Toulouse France
| | - Laure Pourcel
- Equipe de Pharmacoépidémiologie; Inserm, UMR1027; Toulouse France
- Université de Toulouse III, UMR1027; Toulouse France
- Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance; Centre Hospitalier Universitaire; Toulouse France
| | - Sylvie Saivin
- Institut Fédératif de Biologie; Centre Hospitalier Universitaire; Toulouse France
| | - Laurent Molinier
- Département d'Information Médicale; Centre Hospitalier Universitaire; Toulouse France
| | - Maryse Lapeyre-Mestre
- Equipe de Pharmacoépidémiologie; Inserm, UMR1027; Toulouse France
- Université de Toulouse III, UMR1027; Toulouse France
- Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance; Centre Hospitalier Universitaire; Toulouse France
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Abstract
Buprenorphine/naloxone has recently been introduced in Australia and is available for unsupervised dosing within Queensland. A retrospective observational study of data collected during 2000-2007 for clients obtaining injecting equipment from the Brisbane Harm Reduction Centre in Queensland is presented. The numbers of service occasions and needles and syringes were used as surrogate drug use measures. Buprenorphine and naloxone were misused at lower rates when compared with buprenorphine and methadone. Furthermore, the misuse of opioid replacement therapies represented less than 5% of all illicit opioid injections. Implications and study limitations are discussed.
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Affiliation(s)
- Andrew Smirnov
- School of Population Health, University of Queensland, Brisbane, Australia.
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Nordmann S, Frauger E, Pauly V, Orléans V, Pradel V, Mallaret M, Thirion X, Micallef J. Misuse of buprenorphine maintenance treatment since introduction of its generic forms: OPPIDUM survey. Pharmacoepidemiol Drug Saf 2011; 21:184-90. [DOI: 10.1002/pds.2263] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 07/04/2011] [Accepted: 09/12/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Sandra Nordmann
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse; Pharmacologie Clinique, Hôpital Timone, Marseille & Institut des Neurosciences Cognitives de la Méditerranée, Faculté de médecine, UMR 6193-CNRS; Marseille France
| | - Elisabeth Frauger
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse; Pharmacologie Clinique, Hôpital Timone, Marseille & Institut des Neurosciences Cognitives de la Méditerranée, Faculté de médecine, UMR 6193-CNRS; Marseille France
| | - Vanessa Pauly
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse; Centre Associé, Laboratoire de Santé Publique, Faculté de médecine; Marseille France
| | - Veronica Orléans
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse; Centre Associé, Laboratoire de Santé Publique, Faculté de médecine; Marseille France
| | - Vincent Pradel
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse; Centre Associé, Laboratoire de Santé Publique, Faculté de médecine; Marseille France
| | - Michel Mallaret
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance Grenoble; C.H.U. Laboratoire de Pharmacologie; Grenoble, France
| | - Xavier Thirion
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse; Centre Associé, Laboratoire de Santé Publique, Faculté de médecine; Marseille France
| | - Joëlle Micallef
- Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse; Pharmacologie Clinique, Hôpital Timone, Marseille & Institut des Neurosciences Cognitives de la Méditerranée, Faculté de médecine, UMR 6193-CNRS; Marseille France
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Nordmann S, Frauger E, Pauly V, Rouby F, Mallaret M, Micallef J, Thirion X. [Post-marketing surveillance systems for psychoactive prescription drug abuse]. Therapie 2011; 66:263-72. [PMID: 21819810 DOI: 10.2515/therapie/2011045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 03/02/2011] [Indexed: 11/20/2022]
Abstract
Drugs affecting the central nervous system form a unique group of products for surveillance because they could be misused, abused or diverted. Considering the characteristics of this behaviour that is often concealed, specific post-marketing surveillance systems have been developed to monitor abuse of prescription drugs in some countries. The purpose of this review is to list and to describe post-marketing surveillance systems, according their methodology, in France and in foreign countries. These programs are based on adverse effect notifications, medical or legal consequences of abuse, general or specific population-based survey, professional networks or medication databases. Some programs use simultaneously several information sources. In conclusion, the multifaceted nature, the diversity and the inventiveness of post-marketing surveillance systems reflects the complexity of the abuse issue.
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Frauger E, Nordmann S, Orleans V, Pradel V, Pauly V, Thirion X, Micallef J. Which psychoactive prescription drugs are illegally obtained and through which ways of acquisition? About OPPIDUM survey. Fundam Clin Pharmacol 2011; 26:549-56. [DOI: 10.1111/j.1472-8206.2011.00950.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Frauger E, Pauly V, Natali F, Pradel V, Reggio P, Coudert H, Thirion X, Micallef J. Patterns of methylphenidate use and assessment of its abuse and diversion in two French administrative areas using a proxy of deviant behaviour determined from a reimbursement database: main trends from 2005 to 2008. CNS Drugs 2011; 25:415-24. [PMID: 21476612 DOI: 10.2165/11587640-000000000-00000] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Methylphenidate is a psychostimulant drug indicated for the treatment of attention-deficit hyperactivity disorder (ADHD). Its abuse and diversion have been previously described in specific populations, such as students; however, few studies investigating abuse and diversion among the overall population are available. OBJECTIVES The aim of this study was to describe patterns of methylphenidate use and to explore the magnitude of its abuse and diversion in two French administrative areas using data from a reimbursement database. A proxy of 'deviant behaviour' was used for the abuse and diversion of methylphenidate, defined using the following parameters: total number of defined daily doses (DDDs) of methylphenidate dispensed; number of different pharmacies seen for dispensing of methylphenidate; number of prescribers consulted for a prescription of methylphenidate; and number of dispensings of methylphenidate. Data from the reimbursement database were analysed by clustering methods. These data were assessed from 2005 to 2008. METHOD The French General Health Insurance System (GHIS) database was used to obtain data on methylphenidate use in two French administrative areas. Individuals affiliated to the GHIS who had a prescription for methylphenidate reimbursed between 1 January and 31 March of 4 selected years (2005, 2006, 2007 and 2008) were included. After the first dispensing of methylphenidate for these individuals, all their dispensings (including methylphenidate and other psychoactive drugs) were monitored over a 9-month period. Following a descriptive analysis, a clustering method was used to identify different subgroups of subjects according to the methylphenidate consumer profile characteristics. RESULTS With regard to the number of patients who had a dispensing for methylphenidate during the first quarter of the year, an 84% increase was observed between 2005 (n = 640) and 2008 (n = 1175). The clustering method identified two subgroups. One of them was characterized by a higher number of dispensings, different prescribers and pharmacies and a greater total dispensed quantity, suggesting a deviant behaviour and, thus, possible abuse and diversion of methylphenidate. These subjects were older (aged 35.4 ± 11.3 years) and were more frequently patients receiving benzodiazepines, antidepressants, antipsychotics and maintenance opioid treatment. The proportion of subjects with a deviant behaviour increased from 0.5% in 2005 to 2% in 2007 and then decreased to 1.2% in 2008. CONCLUSION This method was able to assess the magnitude of methylphenidate abuse liability and to follow its evolution. The decrease in methylphenidate abuse and diversion seen between 2007 and 2008 can be explained by the enactment in April 2008 of specific regulations for prescription drugs (such as methylphenidate) that are deemed by the French government to have the potential for misuse; these regulations require the establishment of a 'contract of care' between the GHIS, prescriber and patient.
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Affiliation(s)
- Elisabeth Frauger
- Centre dEvaluation et dInformation sur la Pharmacodpendance-Addictovigilance, CEIP-A, Pharmacologie Clinique, CHU Timone, Marseille, France
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Yokell MA, Zaller ND, Green TC, Rich JD. Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review. CURRENT DRUG ABUSE REVIEWS 2011; 4:28-41. [PMID: 21466501 PMCID: PMC3154701 DOI: 10.2174/1874473711104010028] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/24/2011] [Indexed: 11/22/2022]
Abstract
The diversion, misuse, and non-medically supervised use of buprenorphine and buprenorphine/naloxone by opioid users are reviewed. Buprenorphine and buprenorphine/naloxone are used globally as opioid analgesics and in the treatment of opioid dependency. Diversion of buprenorphine and buprenorphine/naloxone represents a complex medical and social issue, and has been widely documented in various geographical regions throughout the world. We first discuss the clinical properties of buprenorphine and its abuse potential. Second, we discuss its diversion and illicit use on an international level, as well as motivations for those activities. Third, we examine the medical risks and benefits of buprenorphine's non-medically supervised use and misuse. These risks and benefits include the effect of buprenorphine's use on HIV risk and the risk of its concomitant use with other medications and drugs of abuse. Finally, we discuss the implications of diversion, misuse, and non-medically supervised use (including potential measures to address issues of diversion); and potential areas for further research.
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Affiliation(s)
- Michael A. Yokell
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI 02906, USA
- Center for AIDS Research, The Miriam Hospital, Providence, RI 02906, USA
| | - Nickolas D. Zaller
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI 02906, USA
- Center for AIDS Research, The Miriam Hospital, Providence, RI 02906, USA
- Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Traci C. Green
- Center for AIDS Research, The Miriam Hospital, Providence, RI 02906, USA
- Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
- Rhode Island Hospital, Providence, RI 02903, USA
| | - Josiah D. Rich
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI 02906, USA
- Center for AIDS Research, The Miriam Hospital, Providence, RI 02906, USA
- Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
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Rouby F, Pradel V, Frauger E, Pauly V, Natali F, Reggio P, Thirion X, Micallef J. Assessment of abuse of tianeptine from a reimbursement database using ‘doctor-shopping’ as an indicator. Fundam Clin Pharmacol 2011; 26:286-94. [DOI: 10.1111/j.1472-8206.2010.00906.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Which indicators can public health authorities use to monitor prescription drug abuse and evaluate the impact of regulatory measures? Controlling High Dosage Buprenorphine abuse. Drug Alcohol Depend 2011; 113:29-36. [PMID: 20692778 DOI: 10.1016/j.drugalcdep.2010.06.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Two methods have been recently developed from a drug reimbursement database to provide useful indicators for public health authorities concerning the abuse potential of psychotropic drugs. The doctor-shopping indicator (DSI) measures the proportion of the drug obtained by doctor shopping among the overall quantity of the drug reimbursed and the clustering method reveals subgroups of deviant patients. OBJECTIVE The objective of the study was to analyze and compare indicators resulting from these two methods, applied to High Dosage Buprenorphine (HDB) (a product well-known to be diverted in France), in order to determine which public health authorities needs they answer. DATA ANALYSIS The patients with reimbursed HDB were grouped using the clustering method in terms of drug dispensations characteristics over a nine month period. The characteristics of the resulting subgroups, including their DSI, were then compared. RESULTS 4787 Patients (73.4%) had no measurable doctor-shopping behaviour. But the comparison of the two methods demonstrated that the more a patient's profile was characterized by deviant behavior, the higher was the DSI: from 0.4% in a subgroup with a median profile to 72% in a subgroup with a deviant profile. CONCLUSION These two methods are useful surveillance tools for public health authorities: the clustering method may help devise pertinent intervention strategies to reduce prescription drug abuse while the DSI method provides quantitative information demonstrating whether these strategies are useful. We discuss the advantages and disadvantages of using these two methods as useful indicators for public health authorities.
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Frauger E, Pauly V, Pradel V, Rouby F, Arditti J, Thirion X, Lapeyre Mestre M, Micallef J. Evidence of clonazepam abuse liability: results of the tools developed by the French Centers for Evaluation and Information on Pharmacodependence (CEIP) network. Fundam Clin Pharmacol 2010; 25:633-41. [PMID: 21077937 DOI: 10.1111/j.1472-8206.2010.00882.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recent observations suggest the existence of clonazepam abuse. To determine its importance in France, a quantitative and systematic synthesis of all clonazepam data of several epidemiological tools of the Centers for Evaluation and Information on Pharmacodependence (CEIP) network has been performed in comparison with data on others benzodiazepines (BZD). Data on clonazepam and other BZD have been analysed from different epidemiological tools: OSIAP survey that identifies drugs obtained by means of falsified prescriptions, Observation of Illegal Drugs and Misuse of Psychotropic Medications (OPPIDUM) survey that describes modalities of use and data from regional French health reimbursement system. In OSIAP survey, the proportion of clonazepam falsified prescriptions among all BZD falsified prescriptions increased. During the 2006 OPPIDUM survey, the analysis of the BZD modalities of use highlights clonazepam abuse liability (for example 23% of illegal acquisition), in second rank after flunitrazepam. Studies based on data from the French health reimbursed system show that 1.5% of subjects with clonazepam dispensing had a deviant behaviour. Among BZD, clonazepam has the second most important doctor-shopping indicator (3%) after flunitrazepam. All these data provide some arguments in favour of clonazepam abuse liability in real life and the necessity to reinforce its monitoring.
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Affiliation(s)
- Elisabeth Frauger
- CEIP-Centre Associé, Fédération de Pharmacologie et de Toxicologie, CHU Timone, Marseille & Institut des Neurosciences Cognitives de la Méditerranée, Faculté de Médecine, UMR 6193 Université de la Méditerranée-CNRS, Marseille, France
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Pradel V, Delga C, Rouby F, Micallef J, Lapeyre-Mestre M. Assessment of abuse potential of benzodiazepines from a prescription database using 'doctor shopping' as an indicator. CNS Drugs 2010; 24:611-20. [PMID: 20527997 DOI: 10.2165/11531570-000000000-00000] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Benzodiazepines are widely used for different purposes because of their pharmacological properties, but their abuse potential may represent a limitation to their use. Data suggest that this abuse potential may vary between products and available dosages. Doctor shopping (the simultaneous use of several physicians by a patient) is one of the most important ways in which prescription drugs, in particular benzodiazepines, are diverted. OBJECTIVE To assess the potential for abuse of several benzodiazepines using doctor shopping in a French administrative area as a proxy for abuse. METHODS All prescriptions reimbursed during the year 2003 in Haute-Garonne, France (one million inhabitants) for benzodiazepines that were available in ambulatory care through community pharmacies as solid oral forms were extracted from a reimbursement database. The benzodiazepines were alprazolam (0.25 mg, 0.50 mg), bromazepam 6 mg, clonazepam 2 mg, clorazepate (5 mg, 10 mg, 50 mg), diazepam (1 mg, 5 mg, 10 mg), flunitrazepam 1 mg, lorazepam (1 mg, 2.5 mg) and tetrazepam 50 mg. For each patient, the quantities prescribed, dispensed and obtained by doctor shopping (i.e. overlap between prescriptions from different prescribers) were computed. Benzodiazepines were compared using their 'doctor shopping indicator' (DSI, the percentage of each drug obtained through doctor shopping among the total reimbursed quantity). RESULTS About 128 000 patients received at least one benzodiazepine during the year. Four groups of benzodiazepines were identified according to their abuse potential: very high abuse potential (flunitrazepam, DSI = 42.8%); high abuse potential (diazepam 10 mg, DSI = 3.2%; clorazepate 50 mg, DSI = 2.7%); intermediate abuse potential (alprazolam 0.50 mg, bromazepam, clonazepam, DSI ranging from 1.8% to 1.9%); and low abuse potential (other benzodiazepines and dosages, DSI ranging from 0.3% to 1.1%). CONCLUSION The DSI can be used to assess the relative abuse liability of benzodiazepines and to detect signals of new patterns of abuse in settings where centralized records of prescription or deliveries are available for the great majority of patients.
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Affiliation(s)
- Vincent Pradel
- Centre d'Evaluation et d'Information sur la Pharmacodépendance CEIP PACA-Corse, centre associé, Service de Pharmacologie Clinique, Marseille, France
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Pauly V, Frauger E, Rouby F, Sirere S, Monier S, Paulet C, Gibaga V, Micallef J, Thirion X. Évaluation des conduites addictives chez les personnes entrant en milieu pénitentiaire à partir du programme OPPIDUM du réseau des centres d’évaluation et d’information sur la pharmacodépendance (CEIP). Encephale 2010; 36:122-31. [DOI: 10.1016/j.encep.2009.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 03/16/2009] [Indexed: 11/15/2022]
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Micallef-Roll J, Lapeyre-Mestre M. Second Meeting of the French CEIP (Centres d’Évaluation et d’Information sur la Pharmacodépendance). Part I: How to Evaluate and Prevent the Abuse and Dependence on Hypnotic/Anxiolytic Drugs? Therapie 2009; 64:355-64. [DOI: 10.2515/therapie/2009054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 07/27/2009] [Indexed: 11/20/2022]
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Abstract
Some observations suggest the existence of clonazepam abuse. The aim of this study was to assess its magnitude in real life by a new method, using a prescription database, and to assess its evolution between 2001 and 2006. Individuals from a region affiliated to the French health reimbursement system, who had a prescription of clonazepam reimbursed between 1 January and 15 February of two selected years were included. Their deliveries were monitored over a 9-month period. After a descriptive analysis, a clustering method illustrated by a factorial analysis was used to identify different subgroups of clonazepam consumers. An increase of 82% in participants who had a delivery of clonazepam between 2001 and 2006 was observed. Using the clustering method, this study identified some deviant participants. This group comprises a higher proportion of males, benzodiazepine users, and buprenorphine users. The number of deliveries by different prescribers and pharmacies are higher. The proportion of deviant participants increased between 2001 and 2006 (from 0.86 to 1.38%). Our method can be used to assess the magnitude of abuse liability of clonazepam and is also interesting for following its evolution, two important keys for assessing patterns of abuse.
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