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Hartmayer LT, Hoffmann F, Bachmann CJ, Jobski K. Characteristics and outcomes of cases with methylphenidate abuse, dependence or withdrawal: an analysis of spontaneous reports in EudraVigilance. Int Clin Psychopharmacol 2023; 38:169-178. [PMID: 36728576 DOI: 10.1097/yic.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Methylphenidate (MPH) is a central nervous stimulant, which is mainly used in attention deficit hyperactivity disorder (ADHD) and narcolepsy. In recent years, rising MPH prescription volumes have drawn attention to possible misuse. We analyzed data on suspected MPH abuse, dependence or withdrawal reported to the EudraVigilance database (1996-2019), comparing case characteristics (e.g. age, indications and outcome). In 1531 cases from 35 countries (median: 29 years, 57.6% male), 42.3% had been diagnosed with ADHD and 8.0% with narcolepsy. Narcolepsy cases were older than ADHD cases (mean age: 47 vs. 22 years), and used co-medications more frequently (79.4 vs. 47.8%). Intravenous MPH administration was most common among individuals not diagnosed with ADHD or narcolepsy. A history of abuse, dependence or withdrawal of any substance was more often documented in fatal than in nonfatal cases (49.0 vs. 22.5%), whereas differences regarding the route of administration were less pronounced. Minors, who presumably received MPH for ADHD treatment, presented less frequently with serious outcomes than older cases or those without an approved indication. Prescribers should exercise caution in adult MPH users and should make a thorough co-medication assessment. Finally, more research on substance abuse in narcolepsy patients is required, which should include comorbidities and co-medication.
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Affiliation(s)
- Lara T Hartmayer
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Christian J Bachmann
- Department of Child and Adolescent Psychiatry, University Hospital Ulm, Ulm, Germany
| | - Kathrin Jobski
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg
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2
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Guerra C, Soeiro T, Lacroix C, Jouve E, Micallef J, Frauger E. [Increasing methylphenidate abuse: Tracking and profiles during 13-years]. Therapie 2022; 77:713-721. [PMID: 35599193 DOI: 10.1016/j.therap.2022.03.006] [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: 02/03/2022] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Methylphenidate is indicated for attention deficit hyperactivity disorder (ADHD). Several studies have evaluated its abuse in specific populations (students, drug users) and few in the general population. This work describes the extent of its abuse in a region of more than 5 million inhabitants. METHOD Based on regional health insurance data from 2005 to 2017, the clustering method identifies different methylphenidate use profiles according to several characteristics (number of different prescribers and pharmacies, number of dispensations, number of defined daily dose dispensed). The groups characterised by high values of these variables will be qualified as "deviant". RESULTS In 13 years, the number of patients with at least one dispensation in the first quarter has been multiplied by 5.8 times. The proportion of adults has increased (20% in 2017) and their number has been multiplied by 10. Five groups are identified, three of them are characterised by "deviant" behaviour. Group 5 (n=11, 0.04%) has higher values than 4 (n=112, 0.4%) and 3 (n=407, 1.6%). These patients are older and more frequently use benzodiazepines and opiate substitution drugs. Groups 1 (n=13,132, 51%) and 2 (n=11,941, 46.7%) are more likely to be taken up by young subjects. The number of subjects with "deviant" behaviour increased until 2011 and after a decrease, the highest number of subjects concerned has been observed since 2015. CONCLUSION In view of the increase of subjects with "deviant" behaviour, it is necessary to make the medical community and patients aware on the risk of abuse of methylphenidate. The recent extension of the indication for ADHD in adults and the broadening of the conditions of prescription require increased vigilance.
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Affiliation(s)
- Clémence Guerra
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Thomas Soeiro
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Clémence Lacroix
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Elisabeth Jouve
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Joelle Micallef
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France
| | - Elisabeth Frauger
- CEIP-Addictovigilance Paca Corse, Service de Pharmacologie Clinique, Hôpital de la Timone, Assistance Publique - Hôpitaux de Marseille ; Aix-Marseille Université, Institut de Neurosciences des Systèmes, Inserm UMR1106, Marseille, France.
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Rolland B. Doctor shopping for methylphenidate as a proxy for misuse and potential abuse in the 67 million inhabitants in France. Fundam Clin Pharmacol 2021; 35:749-750. [PMID: 33774849 DOI: 10.1111/fcp.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, CH Le Vinatier, Lyon, France.,PSYR, CRNL, INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
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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, Frauger É, Pradel V, Micallef J. Doctor shopping for methylphenidate as a proxy for misuse and potential abuse in the 67 million inhabitants in France. Fundam Clin Pharmacol 2020; 35:751-761. [PMID: 33025606 DOI: 10.1111/fcp.12612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/02/2020] [Accepted: 10/01/2020] [Indexed: 01/15/2023]
Abstract
Doctor shopping enables subjects to receive more than the prescribed dose out of any medical management, which suggests a search for high doses and makes doctor shopping a relevant proxy for misuse and potential abuse. Therefore, this study aimed to identify and characterize profiles of subjects with doctor-shopping behavior for methylphenidate in the entire French population. This study is a cross-sectional study of doctor-shopping behavior for methylphenidate in France, in 2016, using the Système national des données de santé, and accounting for overlapping prescriptions. Subjects who obtained >840 mg by doctor shopping were defined as subjects with heavy doctor-shopping behavior, and subjects who obtained >0 mg and ≤840 mg by doctor shopping were defined as subjects with light doctor-shopping behavior. A total of 63 739 subjects were included, and received 339.6 kg of methylphenidate. Among them, 216 (0.3%) subjects had heavy doctor-shopping behavior, and 313 (0.5%) subjects had light doctor-shopping behavior. Compared with subjects with light doctor-shopping behavior, subjects with heavy doctor-shopping behavior were older (64% of 30- to 49-year-old subjects vs. 77% of ≤17-year-old subjects; P < 0.001), received more concomitant dispensings of antipsychotics (37% vs. 26%; P = 0.008) and opioid maintenance treatments (50% vs. 6%; P < 0.001), and had more prescribers (4 [IQR = 2-5] vs. 2 [IQR = 2-3]; P < 0.001). In the French context where prescription and dispensing of methylphenidate are highly regulated and methylphenidate is much less used than in other countries, these results are a warning signal to avoid trivializing methylphenidate in adults.
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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, 264 rue Saint Pierre, Marseille, 13005, France
| | - Élisabeth Frauger
- 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, 264 rue Saint Pierre, Marseille, 13005, 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, 264 rue Saint Pierre, Marseille, 13005, 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, 264 rue Saint Pierre, Marseille, 13005, France
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Lancia M, Gambelunghe A, Gili A, Bacci M, Aroni K, Gambelunghe C. Pregabalin Abuse in Combination With Other Drugs: Monitoring Among Methadone Patients. Front Psychiatry 2020; 10:1022. [PMID: 32116826 PMCID: PMC7026508 DOI: 10.3389/fpsyt.2019.01022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/24/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In recent years, there has been an increase in the non-medical use of psychoactive prescription drugs including pregabalin (PGB). Studies have shown that multiple drug users and patients in methadone treatment programs administered PGB at high dosages in order to achieve euphoria, reduce withdrawal symptoms, or potentiate the effects of methadone. For these reasons, accurate toxicological monitoring is required for these high-risk individuals. MATERIALS AND METHODS The present study investigated whether PGB could be detected in the hair samples of 250 patients with a history of opiate dependency, and under toxicological surveillance assess their compliance with methadone maintenance therapy. RESULTS Opiates were found in 54/250 of all hair samples, while cannabis was present in 74/250 patients, cocaine was detected in 21/250 patients, and benzodiazepines without prescription were identified in 49/250 patients. As expected, methadone was present in all 250 patients (100%). PGB without prescription was found in the hair samples of 35/250 patients (14%). Of these, 91.43% were male, 48.57% were <30 y old, and 45.71% were between ages 30 and 50 y. There were no apparent associations among PGB use, daily methadone dosage, and duration of methadone maintenance therapy. Psychiatric comorbidities were present in 25.71% of the patients abusing PGB. Anxiety (55.56%) and depression (33.33%) were the most prevalent psychiatric disorders. DISCUSSION Most of the patients taking PGB (57.14%) used other drugs (especially opiates) concurrently. The utility of hair analysis is explained by easy and rapid sample collection and the ability of the hair to reflect long-term drug use and incorporate drug metabolites. The findings of this study suggested that PGB has significant potential for abuse by high-risk populations such as opioid users and patients with dual diagnosis. These risks are particularly high in cases of poly-drug use and drug intake that are not in compliance with prescription guidelines.
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Affiliation(s)
- Massimo Lancia
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Angela Gambelunghe
- Occupational Medicine, Respiratory Diseases and Toxicology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessio Gili
- Hygiene and Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Mauro Bacci
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Kyriaki Aroni
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Cristiana Gambelunghe
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
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Faraone SV, Rostain AL, Montano CB, Mason O, Antshel KM, Newcorn JH. Systematic Review: Nonmedical Use of Prescription Stimulants: Risk Factors, Outcomes, and Risk Reduction Strategies. J Am Acad Child Adolesc Psychiatry 2020; 59:100-112. [PMID: 31326580 DOI: 10.1016/j.jaac.2019.06.012] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/26/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To review all literature on the nonmedical use (NMU) and diversion of prescription stimulants to better understand the characteristics, risk factors, and outcomes of NMU and to review risk-reduction strategies. METHOD We systematically searched PubMed, PsycINFO, and SCOPUS from inception to May 2018 for studies containing empirical data about NMU and diversion of prescription stimulants. Additional references identified by the authors were also assessed for inclusion. RESULTS A total of 111 studies met inclusion criteria. NMU and diversion of stimulants are highly prevalent; self-reported rates among population samples range from 2.1% to 58.7% and from 0.7% to 80.0%, respectively. A variety of terms are used to describe NMU, and most studies have examined college students. Although most NMU is oral, non-oral NMU also occurs. The majority of NMU is associated with no, or minor, medical effects; however, adverse medical outcomes, including death, occur in some individuals, particularly when administered by non-oral routes. Although academic and occupational performance enhancement are the most commonly cited motivations, there is little evidence that academic performance is improved by NMU in individuals without attention-deficit/hyperactivity disorder. CONCLUSION NMU of stimulants is a significant public health problem, especially in college students, but variations in the terms used to describe NMU and inconsistencies in the available data limit a better understanding of this problem. Further research is needed to develop methods to detect NMU, identify individuals at greatest risk, study routes of administration, and devise educational and other interventions to help reduce occurrence of NMU. Colleges should consider including NMU in academic integrity policies.
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Affiliation(s)
| | - Anthony L Rostain
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | | | | | - Kevin M Antshel
- SUNY Upstate Medical University, Syracuse, NY; Syracuse University, NY
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Dupui M, Micallef J, Lapeyre-Mestre M. Interest of large electronic health care databases in addictovigilance: Lessons from 15 years of pharmacoepidemiological contribution. Therapie 2019; 74:307-314. [DOI: 10.1016/j.therap.2018.09.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/29/2018] [Indexed: 10/27/2022]
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9
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Gisev N, Pearson SA, Dobbins T, Currow DC, Blyth F, Larney S, Dunlop A, Mattick RP, Wilson A, Degenhardt L. Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol. BMJ Open 2018; 8:e025840. [PMID: 30518593 PMCID: PMC6286479 DOI: 10.1136/bmjopen-2018-025840] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Opioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms. METHODS AND ANALYSIS We will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use. ETHICS AND DISSEMINATION This study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Drug and Alcohol Clinical Services, Hunter New England, Newcastle, New South Wales, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
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Gentile G, Jego M, Spadari M, Griffiths K, Jouanjus E, Micallef J. Identification and tracking of Addictovigilance signals in general practice: which interactions between the general practitioners and the French Addictovigilance Network? Fundam Clin Pharmacol 2018; 32:643-651. [PMID: 30003596 DOI: 10.1111/fcp.12401] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 06/30/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022]
Abstract
Addictovigilance is a health vigilance dedicated to the survey of medicinal or illicit psychoactive substance use disorders (SUDs). France is the only European country to have a vigilance system specifically dedicated to substances with an abuse/addiction potential. The French Addictovigilance system is organized in a network of regional tertiary centres (called Abuse and Dependence Monitoring Centres, CEIP-Addictovigilance) and works in close collaboration with Regional and National health authorities. Because of the essential and unavoidable nature of their practice in the French Healthcare system, general practitioners (GPs) are key actors to identify and track Addictovigilance signals. They have been involved in several of the pharmacoepidemiological surveys implemented by the French Addictovigilance Network (FAN). Now, they increasingly participate in clinical research projects and studies. In this article, interactions between GPs and the FAN are illustrated with two examples: patients on opioid substitution treatment and patients on opioid analgesics. Collaborations between GPs and the FAN could be further potentiated. In particular, more effective communication on psychoactive SUDs including abuse/addiction is necessary to optimize the implementation of preventive measures for patients on psychoactive substances medications, and to improve the attitudes of GPs and more widely health professionals in the management of any psychoactive user suffering from SUDs. In addition, both adapted training and improved collaborative research could contribute to the optimization (safety, quality) of professional practices.
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Affiliation(s)
- Gaétan Gentile
- Département Universitaire de Médecine Générale, Faculté de Médecine, Aix Marseille Université, 27 boulevard Jean Moulin, Marseille, 13385, France.,Institut des Neurosciences des Systèmes, INSERM 1106, Aix Marseille Université, INSERM, INS, Inst Neurosci Syst, Faculté Médecine Timone, 27 Bd Jean Moulin, 133855, Marseille, France
| | - Maeva Jego
- Département Universitaire de Médecine Générale, Faculté de Médecine, Aix Marseille Université, 27 boulevard Jean Moulin, Marseille, 13385, France.,EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, CERESS, EA3279, 27 Bd Jean Moulin, Marseille, 13385, France
| | - Michel Spadari
- Institut des Neurosciences des Systèmes, INSERM 1106, Aix Marseille Université, INSERM, INS, Inst Neurosci Syst, Faculté Médecine Timone, 27 Bd Jean Moulin, 133855, Marseille, France.,CEIP-Addictovigilance PACA Corse, Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Marseille, 13385, France
| | - Karolina Griffiths
- Département Universitaire de Médecine Générale, Faculté de Médecine, Aix Marseille Université, 27 boulevard Jean Moulin, Marseille, 13385, France
| | - Emilie Jouanjus
- Equipe de Pharmacoépidémiologie, INSERM UMR 1027, Université Toulouse III - Paul Sabatier, 37 Allées Jules Guesde, Toulouse, 31000, France.,CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, 37 Allées Jules Guesde, Toulouse, 31000, France
| | - Joëlle Micallef
- Institut des Neurosciences des Systèmes, INSERM 1106, Aix Marseille Université, INSERM, INS, Inst Neurosci Syst, Faculté Médecine Timone, 27 Bd Jean Moulin, 133855, Marseille, France.,CEIP-Addictovigilance PACA Corse, Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Marseille, 13385, France
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Ehrhardt C, Boucherie Q, Pauly V, Braunstein D, Ronflé E, Thirion X, Frauger E, Micallef J. Methylphenidate: Gender trends in adult and pediatric populations over a 7 year period. Therapie 2017; 72:635-641. [DOI: 10.1016/j.therap.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 01/11/2023]
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12
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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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Martinez-Raga J, Ferreros A, Knecht C, de Alvaro R, Carabal E. Attention-deficit hyperactivity disorder medication use: factors involved in prescribing, safety aspects and outcomes. Ther Adv Drug Saf 2016; 8:87-99. [PMID: 28382197 DOI: 10.1177/2042098616679636] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
While treatment of patients with attention-deficit hyperactivity disorder (ADHD) is based on a multimodal approach that combines medication with specific psychological interventions, pharmacotherapy alone is generally considered an essential and cost-effective element. This paper aims to comprehensively and critically review factors involved in prescribing and medication use in individuals diagnosed with ADHD, focusing on the difficulties facing patients with ADHD seeking treatment, as well as the safety and tolerability aspects of ADHD pharmacotherapies, with particular attention on the cardiovascular adverse events and the potential risk of misuse or diversion of ADHD medications. A comprehensive and systematic literature search of PubMed/MEDLINE database was conducted to identify studies published in peer-reviewed journals until 1 August 2016. Children, adolescents and adults often encounter significant difficulties in the process of accessing specialist assessment and treatment for ADHD as a consequence of disparities in service organization and available treatment provision. Despite the well-established efficacy and overall safety profile, ADHD medications are not exempt from adverse events. The cardiovascular safety of pharmacotherapies used for treating individuals with ADHD has raised particular concerns; however there is little evidence of serious cardiovascular adverse events, including no serious corrected QT (QTc) abnormalities associated with stimulants, atomoxetine or α2-adrenergic receptor agonists. Although the abuse of prescription stimulant drugs, particularly, short-acting stimulants is a prevalent and growing problem, nonmedical use of prescription stimulants within the clinical context is very limited. In addition, nonstimulant ADHD medications lack any reinforcing effects and consequently any abuse potential.
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Affiliation(s)
- Jose Martinez-Raga
- Teaching Unit of Psychiatry and Clinical Psychology, University of Valencia, University Cardenal Herrera CEU and Hospital Universitario Doctor Peset, Avda. Gaspar Aguilar, 90, 46017 Valencia, Spain
| | | | - Carlos Knecht
- Mental Health Area, Hospital Padre Jofré, Valencia, Spain
| | - Raquel de Alvaro
- Hospital General de Castellón, Consorcio Hospitalario Provincial, Castellón, Spain
| | - Eloisa Carabal
- Teaching Unit of Psychiatry and Clinical Psychology, University Hospital Doctor Peset, Valencia, Spain University Cardenal Herrera CEU, Valencia, Spain
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Peyriere H, Nogue E, Eiden C, Frauger E, Charra M, Picot MC. Evidence of slow-release morphine sulfate abuse and diversion: epidemiological approaches in a French administrative area. Fundam Clin Pharmacol 2016; 30:466-75. [DOI: 10.1111/fcp.12210] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Hélène Peyriere
- Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance; Département de Pharmacologie Médicale et Toxicologie; CHRU Montpellier; F-34295 Montpellier France
| | - Erika Nogue
- Unité de recherche clinique et épidémiologique; Département de l'Information Médicale; Hôpital La Colombière; CHRU Montpellier; F-34295 Montpellier France
| | - Céline Eiden
- Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance; Département de Pharmacologie Médicale et Toxicologie; CHRU Montpellier; F-34295 Montpellier France
| | - Elisabeth Frauger
- Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance Paca Corse; Service de Pharmacologie Clinique et Pharmacovigilance; CHU Timone; Assistance Publique-Hôpitaux de Marseille; Marseille France
- UMR 7289 Aix Marseille Université-CNRS; Institut des Neurosciences Timone; secteur PiiCi F-13005 Marseille France
| | - Maryline Charra
- Echelon Régional du Service Médical; Caisse nationale d'Assurance Maladie des Travailleurs Salariés; F-34967 Montpellier France
| | - Marie-Christine Picot
- Unité de recherche clinique et épidémiologique; Département de l'Information Médicale; Hôpital La Colombière; CHRU Montpellier; F-34295 Montpellier France
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15
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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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Donnet A, Braunstein D, Pradel V, Sciortino V, Allaria-Lapierre V, Micallef J, Lanteri-Minet M. Ergot Use and Overuse: A Pharmacoepidemiology Retrospective Cohort Study. Headache 2016; 56:547-54. [DOI: 10.1111/head.12776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Donnet
- Centre d’évaluation et de traitement de la douleur, Hôpital Timone, Pôle Neurosciences Cliniques; Hôpital de la Timone; Marseille France
- INSERM/UdA, U1107, Neuro-Dol; Clermont-Ferrand France
| | - D. Braunstein
- Aix Marseille Université, CNRS 7289-Institut de Neurosciences Timone, Centre d'Evaluation et d'Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Médicale et Clinique, AP-HM; Marseille France
| | - V. Pradel
- Aix Marseille Université, CNRS 7289-Institut de Neurosciences Timone, Centre d'Evaluation et d'Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Médicale et Clinique, AP-HM; Marseille France
| | - V. Sciortino
- Direction Régionale du Service Médical de l'Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS); Marseille France
| | - V. Allaria-Lapierre
- Direction Régionale du Service Médical de l'Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS); Marseille France
| | - J. Micallef
- Aix Marseille Université, CNRS 7289-Institut de Neurosciences Timone, Centre d'Evaluation et d'Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Médicale et Clinique, AP-HM; Marseille France
| | - M. Lanteri-Minet
- INSERM/UdA, U1107, Neuro-Dol; Clermont-Ferrand France
- Département d'Evaluation et Traitement de la Douleur; Pôle Neurosciences Cliniques du CHU de Nice, Hôpital Cimiez; Nice France
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Blanch B, Buckley NA, Mellish L, Dawson AH, Haber PS, Pearson SA. Harmonizing post-market surveillance of prescription drug misuse: a systematic review of observational studies using routinely collected data (2000-2013). Drug Saf 2016; 38:553-64. [PMID: 25968812 DOI: 10.1007/s40264-015-0294-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Prescription drug misuse is a growing public health concern globally. Routinely collected data provide a valuable tool for quantifying prescription drug misuse. OBJECTIVE To synthesize the global literature investigating prescription drug misuse utilizing routinely collected, person-level prescription/dispensing data to examine reported measures, documented extent of misuse and associated factors. METHODS The MEDLINE, EMBASE, CINAHL, MEDLINE In Process, Scopus citations and Google Scholar databases were searched for relevant articles published between 1 January 2000 and 31 July 2013. A total of 10,803 abstracts were screened and 281 full-text manuscripts were retrieved. Fifty-two peer-reviewed, English-language manuscripts met our inclusion criteria-an aim/method investigating prescription drug misuse in adults and a measure of misuse derived exclusively from prescription/dispensing data. RESULTS Four proxies of prescription drug misuse were commonly used across studies: number of prescribers, number of dispensing pharmacies, early refills and volume of drugs dispensed. Overall, 89 unique measures of misuse were identified across the 52 studies, reflecting the heterogeneity in how measures are constructed: single or composite; different thresholds, cohort definitions and time period of assessment. Consequently, it was not possible to make definitive comparisons about the extent (range reported 0.01-93.5 %), variations and factors associated with prescription drug misuse. CONCLUSIONS Routine data collections are relatively consistent across jurisdictions. Despite the heterogeneity of the current literature, our review identifies the capacity to develop universally accepted metrics of misuse applied to a core set of variables in prescription/dispensing claims. Our timely recommendations have the potential to unify the global research field and increase the capacity for routine surveillance of prescription drug misuse.
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Affiliation(s)
- Bianca Blanch
- Pharmacoepidemiology and Pharmaceutical Policy Research Group, Faculty of Pharmacy, University of Sydney, A15-Pharmacy and Bank Building, Sydney, NSW, 2006, Australia,
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Donfrancesco R, Marano A, Calderoni D, Mugnaini D, Thomas F, Di Trani M, Innocenzi M, Vitiello B. Prevalence of severe ADHD: an epidemiological study in the Italian regions of Tuscany and Latium. Epidemiol Psychiatr Sci 2015; 24:525-33. [PMID: 25221947 PMCID: PMC8367368 DOI: 10.1017/s2045796014000523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/29/2014] [Accepted: 06/11/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The rate with which attention deficit/hyperactivity disorder (ADHD) is diagnosed varies widely across countries, suggesting that cultural factors influence the clinical interpretation of child behaviour. This study estimated the point prevalence of severe ADHD among elementary and middle-school Italian children. METHOD An epidemiological sample of 2016 children attending 2nd-8th grade in the Italian regions of Tuscany and Latium was selected based on census distribution of the school-age population. Teachers completed the Italian version of the ADHD Rating Scale for Teachers (SDAI). For children with at least six inattention symptoms and/or at least six hyperactivity/impulsivity symptoms rated 'very often' by the teachers, the parents completed the Italian ADHD Rating Scale for Parents (SDAG). Children with documented ADHD symptoms at both school and home received a complete psychiatric interview with the Kiddie Schedule for Affective Disorders and Schizophrenia-present and lifetime version (K-SADS-PL). RESULTS Of the 1887 assessed children, 4.45% (95% CI 3.58-5.51) met the ADHD cut-off on teacher ratings, 1.43% (0.96-2.12) had ADHD symptoms endorsed by both teacher and parent, and 1.32% (0.87-1.97) were further confirmed by the psychiatric evaluation. The male:female ratio was 7:1. The inattentive type accounted for about half of the ADHD cases. CONCLUSIONS When applying stringent criteria for both severity and pervasiveness of symptoms, it is estimated that about 1.3% of the Italian elementary and middle-school children suffer from severe ADHD.
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Affiliation(s)
| | - A. Marano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - D. Mugnaini
- Centre for Neuropsychological Assessment, Local Health Service of Florence, Florence, Italy
| | - F. Thomas
- National Health System-ASL Roma B, Roma, Italy
| | - M. Di Trani
- Department of Clinical and Dynamic Psychology, ‘Sapienza’ University, Rome, Italy
| | | | - B. Vitiello
- National Institute of Mental Health, Bethesda, Maryland, USA
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Rasmussen L, Zoëga H, Hallas J, Pottegård A. Deviant patterns of methylphenidate use in adults: a Danish nationwide registry-based drug utilization study. Pharmacoepidemiol Drug Saf 2015; 24:1189-96. [PMID: 26278467 DOI: 10.1002/pds.3852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 06/29/2015] [Accepted: 07/15/2015] [Indexed: 11/11/2022]
Abstract
PURPOSE Several survey studies have documented misuse of methylphenidate defined as the use of non-prescribed methylphenidate or use different from what was prescribed. We aimed to identify and characterize adults with deviant patterns of methylphenidate use in Denmark during 2007-2012. Further, we aimed to identify risk factors associated with deviant patterns of use. METHODS Based on individual-level prescription data, new users of methylphenidate were followed for one year after filling their first prescription on methylphenidate. Adult patients were identified with deviant patterns of use if they had ≥4 different prescribers and filled ≥1095 defined daily doses of methylphenidate during the year of follow-up. Risk factors were estimated by using logistic regression. RESULTS Among 20 829 new users of methylphenidate, we identified 82 (0.39%) patients displaying deviant patterns of use. Characteristics associated with deviant patterns of use included an initial prescription for extended-release methylphenidate (OR2 4.35), age 25-49 years at first prescription (OR2 2.49), general practitioners or hospital doctors as initial prescribers (OR2 3.06 and OR2 4.07) and prior use of drugs used in addictive disorders (OR2 2.08) or opioids (OR2 1.75). Sensitivity analyses revealed that the number of different prescribers alone does not seem to effectively identify deviant users of methylphenidate. CONCLUSION We have identified characteristics associated with deviant patterns of methylphenidate use. Our results do not allow us to conclude if deviant users truly represent medical misusers.
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Affiliation(s)
- Lotte Rasmussen
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Helga Zoëga
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Jesper Hallas
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Anton Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Abstract
Objective Attention-deficit hyperactivity disorder (ADHD) medications are subject to abuse, misuse, and diversion. Obtaining ADHD prescriptions from multiple prescribers or filled across multiple pharmacies, known as ‘doctor shopping’, may reflect such unsanctioned use. We sought to create a definition of shopping behavior that differentiated ADHD medications from medications with low risk of diversion, i.e. asthma medications, and describe the incidence, frequency, and demography of shopping behavior. Methods This was a retrospective cohort study in a pharmacy database—LRx—covering 65 % of US retail pharmacies. Subjects had ADHD or asthma medication dispensed between February 2011 and January 2012. We followed subjects for 18 months to assess the number with overlapping dispensings from different prescribers, and the number of prescribers and pharmacies involved in those dispensings. Results We included 4,402,464 subjects who were dispensed ADHD medications, and 6,128,025 subjects who were dispensed asthma medications. Overlapping prescriptions from two or more prescribers dispensed by three or more pharmacies was four times more frequent in the ADHD cohort than in the asthma cohort. Using this definition, ADHD medication shopping behavior was more common among experienced users than naïve users, and was most common in subjects aged 10–39 years. Among subjects who shopped, 57.4 % shopped only once (accounting for 22.4 % of episodes), and 9.2 % shopped six or more times (accounting for 42.0 % of episodes). Shoppers more often received stimulant ADHD drugs than non-stimulants. Conclusions Overlapping prescriptions by different prescribers and filled at three or more pharmacies defines ADHD medication shopping. Shopping behavior is most common in adolescents and younger adults. A small proportion of shoppers is responsible for a large number of shopping episodes.
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Jensen LS, Pagsberg AK, Dalhoff KP. Differences in abuse potential of ADHD drugs measured by contrasting poison centre and therapeutic use data. Clin Toxicol (Phila) 2015; 53:210-4. [DOI: 10.3109/15563650.2015.1016164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Micallef J, Frauger E, Palmaro A, Boucherie Q, Mestre ML. Un exemple d’investigation d’un phénomène « émergent » en addictovigilance : à propos du méthylphénidate. Therapie 2015; 70:191-6. [DOI: 10.2515/therapie/2015012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 01/09/2023]
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Micallef J, Frauger E, Palmaro A, Boucherie Q, Mestre ML. Example of an Investigation of an “Emergent” Phenomenon in Addiction Vigilance: the Case of Methylphenidate. Therapie 2015; 70:191-202. [DOI: 10.2515/therapie/2015013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 12/31/2022]
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Peles E, Schreiber S, Linzy S, Domani Y, Adelson M. Differences in methylphenidate abuse rates among methadone maintenance treatment patients in two clinics. J Subst Abuse Treat 2014; 54:44-9. [PMID: 25605438 DOI: 10.1016/j.jsat.2014.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 12/13/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
Methylphenidate, an amphetamine-like prescription medication for attention deficit hyperactivity disorder (ADHD) was suspected as being abused among methadone maintenance treatment (MMT) patients. We tested its presence in the routine urine monitoring of all patients in both Tel Aviv and Las Vegas MMT clinics. Data on demographic and addiction history, ADHD (Wender Utah Rating Scale), cognitive impairment (Mini Mental State Exam), and lifetime DSM-IV-TR psychiatric diagnosis from admission were retrieved, and retention following 6 months. None of the 190 patients in Las Vegas tested positive for methylphenidate, while 14.7% (45/306) did in Tel Aviv. Abusers were less educated (p = 0.01), had higher ADHD scores (p = 0.02), lower cognitive scores (p = 0.05), and a higher benzodiazepine (BDZ) abuse rate (p < 0.0005), with no difference in age, gender, duration in MMT, cannabis, opiates, and cocaine abuse and infectious disease. Of the methylphenidate abuse 42.2% have take-home methadone dose privileges. Not like opiate use, being methylphenidate positive did not relate to 6-months retention. Compared to Tel Aviv, Las Vegas patients were more educated, with lower BDZ, and cocaine abuse. The greater abuse of methylphenidate among ADHD subjects might indicate their using it as self-medication, raising a possible indication for its prescription for that subgroup of MMT patients. The high rate of methylphenidate abuse in Israel needs future study.
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Affiliation(s)
- Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv, Israel; Department of Psychiatry, Tel-Aviv Sourasky Medical Center & Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel.
| | - Shaul Schreiber
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv, Israel; Department of Psychiatry, Tel-Aviv Sourasky Medical Center & Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Shirley Linzy
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Las Vegas, NV, USA
| | - Yoav Domani
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv, Israel; Department of Psychiatry, Tel-Aviv Sourasky Medical Center & Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv, Israel; Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Las Vegas, NV, USA
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Detection of signals of abuse and dependence applying disproportionality analysis. Eur J Clin Pharmacol 2014; 71:229-36. [DOI: 10.1007/s00228-014-1783-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/10/2014] [Indexed: 12/13/2022]
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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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Trenque T, Herlem E, Abou Taam M, Drame M. Methylphenidate off-label use and safety. SPRINGERPLUS 2014; 3:286. [PMID: 25279275 PMCID: PMC4162523 DOI: 10.1186/2193-1801-3-286] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/25/2014] [Indexed: 12/17/2022]
Abstract
Introduction Methylphenidate is a piperidine derivative structurally and pharmacologically similar to amphetamine. Methylphenidate is indicated for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 6 years of age and over when remedial measures alone prove insufficient. In adults, its indication, except in narcolepsy, is not defined. Methylphenidate received regulatory approval almost sixty years ago with a first registration in Switzerland in October 1954. Objective To evaluate the off-label use of methylphenidate and its characteristics from a database of spontaneous reports. Methods This study analysed data from the French Pharmacovigilance Database of adverse drug reactions spontaneously reported by health professionals from 1985 to December 2011. Off-label use was evaluated according to age. Results In the French Pharmacovigilance database, 181 cases of adverse drug reactions were reported with methylphenidate. Neuropsychiatric effects were the most frequent adverse event reported (41%) followed by cardiovascular and cutaneous side effects (14%). 143 reports concerned children (113 boys, 30 girls, mean age 10.6 ± 3.3 years) of which 46 (30%) were off-label uses. There were 38 adults (20 men, 18 women), of which 32 (88%) off-label use. In adults, methylphenidate was prescribed for depression, and this practice was associated with serious adverse events of drug dependence, overdose and suicide attempt. Overall, off-label use was detected in 43% (78/181) of all cases reported. Conclusion More than 40% of the patients with drug reactions received methylphenidate for off-label indications. Additional long-term exposures and independent clinical studies are necessary to establish the long-term profile safety of methylphenidate.
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Affiliation(s)
- Thierry Trenque
- Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims University Hospitals, Avenue du General Koenig, 51092, Reims, France ; Faculty of Medicine, University of Reims Champagne-Ardenne, EA 3797, F-51095 Reims, France
| | - Emmanuelle Herlem
- Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims University Hospitals, Avenue du General Koenig, 51092, Reims, France
| | - Malak Abou Taam
- Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Reims University Hospitals, Avenue du General Koenig, 51092, Reims, France
| | - Moustapha Drame
- Faculty of Medicine, University of Reims Champagne-Ardenne, EA 3797, F-51095 Reims, France ; Department of Research and Innovations, Reims University Hospitals, Avenue du General Koenig, 51092 Reims, France
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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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Ramos-Quiroga JA, Montoya A, Kutzelnigg A, Deberdt W, Sobanski E. Attention deficit hyperactivity disorder in the European adult population: prevalence, disease awareness, and treatment guidelines. Curr Med Res Opin 2013; 29:1093-104. [PMID: 23742051 DOI: 10.1185/03007995.2013.812961] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobiological disorder with childhood onset and persistence into adolescence and adulthood. METHODS Our literature review reports scientific publications and guidelines on the treatment of adult ADHD, with a particular focus on European countries, identified by literature searches in Medline and Embase. The final literature search was performed in July 2012, incorporating literature from 1974 to 2012. The primary research parameters were 'Europe' (including single European countries), 'ADHD', 'attention deficit disorder', 'attention deficit', 'attention disorder', and 'hyperactivity'. Secondary search parameters were 'comorbid', 'epidemiology' or 'prevalence', 'disease management', 'drug therapy', or 'therapy'. The main searches were also limited to adults and English language publications. The papers identified by this literature review were selected for inclusion by consensus of the authors based on clinical relevance. RESULTS Appropriate resources for the diagnosis and treatment of adult ADHD in Europe are scarce, and many cases go untreated, particularly because of the frequent presence of psychiatric comorbidities. Apart from atomoxetine, and an extended-release form of methylphenidate in Germany, no other medications have been approved for starting treatment in adult ADHD patients in the European Union. However, a variety of stimulant and non-stimulant medications are used off-label, and a number of studies have confirmed that these medications are well tolerated and effective in adult patients with ADHD. CONCLUSIONS Our results emphasize the need for broader access to effective treatments for adult ADHD patients in Europe.
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Victorri-Vigneau C, Feuillet F, Wainstein L, Grall-Bronnec M, Pivette J, Chaslerie A, Sébille V, Jolliet P. Pharmacoepidemiological characterisation of zolpidem and zopiclone usage. Eur J Clin Pharmacol 2013; 69:1965-72. [PMID: 23877252 DOI: 10.1007/s00228-013-1557-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 07/01/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Caroline Victorri-Vigneau
- Department of Clinical Pharmacology, Center for Evaluation and Information on Pharmacodependence, Nantes University Hospital, Nantes, France,
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Abstract
This paper provides a selective overview of the past, present and future of pediatric psychopharmacology. The acceptance of medication use in child psychiatry was based on the results of double-blind, placebo-controlled trials documenting the efficacy of drug treatments for attention-deficit/hyperactivity disorder, enuresis, depression, anxiety disorders, obsessive-compulsive disorder and psychoses. This period of success was followed by a series of challenges, including a growing awareness of the long-term adverse effects of medications and of the inadequacy of long-term drug surveillance. There is great concern today that children are being overtreated with medication, especially in the US. Further advances in pediatric psychopharmacology may come from examination of large medical data sets including both pharmacological and psychiatric information, which could lead to drug repurposing, as well as from preclinical translational studies such as those using human induced pluripotent stem cells.
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Affiliation(s)
- Judith L. Rapoport
- Child Psychiatry Branch, National Institute of Mental Health; Bethesda; MD; USA
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Dupouy J, Dassieu L, Bourrel R, Poutrain JC, Bismuth S, Oustric S, Lapeyre-Mestre M. Effectiveness of drug tests in outpatients starting opioid substitution therapy. J Subst Abuse Treat 2013; 44:515-21. [DOI: 10.1016/j.jsat.2012.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 11/24/2022]
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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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Bellanger L, Vigneau C, Pivette J, Jolliet P, Sébille V. Discrimination of psychotropic drugs over-consumers using a threshold exceedance based approach. Stat Anal Data Min 2012. [DOI: 10.1002/sam.11165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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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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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Casati A, Sedefov R, Pfeiffer-Gerschel T. Misuse of medicines in the European Union: a systematic review of the literature. Eur Addict Res 2012; 18:228-45. [PMID: 22572594 DOI: 10.1159/000337028] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 01/30/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although awareness of the misuse of medicines is increasing, data on the extent of the problem in the European Union (EU) are lacking. METHODS In order to assess the magnitude and severity of the problem, a systematic review of the literature on the misuse of analgesics, opioid substitution medicines and sedatives/hypnotics (with the exception of benzodiazepines) was conducted using the PubMed and Web of Science databases. Relevant literature was identified between 2001 and 2011. RESULTS The main groups of misused medicines include opioid analgesics, methadone, buprenorphine and Z-drugs. Regional trends in medicine misuse indicate heterogeneity across the EU with respect to misused medicine types and research activities. Prevalence, high-risk populations and factors contributing to medicine misuse are discussed. CONCLUSION The implications of these findings for prevention, treatment, and policy in the EU are considered.
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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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