1
|
Nordmann S, Nefau T, Micallef J, Duplessy C, Catusse JC, Frauger E. [Which psychoactives substances are found in used syringes?]. Therapie 2023; 78:S51-S57. [PMID: 27771105 DOI: 10.2515/therapie/2015054] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/16/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study is to analyze the residual content of used syringes. METHODS Used syringes were collected in March 2014 at 9 sites in Marseille (automatic injection kit dispensers, streets, drug-user risk reduction centers [Centres d'accueil et d'accompagnement à la réduction de risques pour usagers de drogues [CAARUD]). Several substances (n=28) were investigated using liquid chromatography and mass spectrometry method. RESULTS On average, 2±1 substances in each syringe were found among 254 syringes analyzed. The most detected substances were cocaine, buprenorphine, methylphenidate and cathinones (in 57 %, 56 %, 39 % and 19 % of the syringes respectively). Heroin and morphine were found in 10 % of the syringes. DISCUSSION-CONCLUSION This study helps define the main substances consumed by injection drugs users. It highlighted differencies in used substances according to neighborhood and site of collection and thus help to adjust prevention and harm reduction strategies.
Collapse
Affiliation(s)
- Sandra Nordmann
- UMR 7289, institut des neurosciences Timone, service de pharmacologie clinique et pharmacovigilance, CEIP-addictovigilance PACA-Corse, CHU Timone, AP-HM, Aix-Marseille université-CNRS, secteur PiiCi, 13385 Marseille cedex 5, France
| | - Thomas Nefau
- Laboratoire de Santé publique - Environnement, UMR 8079, université Paris Sud, 92290 Châtenay-Malabry, France
| | - Joëlle Micallef
- UMR 7289, institut des neurosciences Timone, service de pharmacologie clinique et pharmacovigilance, CEIP-addictovigilance PACA-Corse, CHU Timone, AP-HM, Aix-Marseille université-CNRS, secteur PiiCi, 13385 Marseille cedex 5, France
| | | | - Jean-Christophe Catusse
- Centre d'accueil et d'accompagnement et de réduction des risques pour les usagers de drogues Sleep'in, groupe PSA/SOS, 13001 Marseille, France
| | - Elisabeth Frauger
- UMR 7289, institut des neurosciences Timone, service de pharmacologie clinique et pharmacovigilance, CEIP-addictovigilance PACA-Corse, CHU Timone, AP-HM, Aix-Marseille université-CNRS, secteur PiiCi, 13385 Marseille cedex 5, France.
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Micallef J, Jouanjus É, Mallaret M, Lapeyre Mestre M. [Safety signal detection by the French Addictovigilance Network: Innovative methods of investigation, examples and usefulness for public health]. Therapie 2019; 74:579-590. [PMID: 31694770 DOI: 10.1016/j.therap.2019.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
Abstract
The French Addictovigilance Network aims to monitor all psychoactive substances with abuse potential including prescription drugs and other legal and illegal substances such as new psychoactive substances (NPS) and its consequences in humans. Created in 1990 through a network of regional addictovigilance centres covering the entire country, these pharmacologists with expertise in addictovigilance have developed interface with different partners (physicians, toxicologists, network of community pharmacies, addictology care centers…) and implemented several original tools of pharmacosurveillance (such as DRAMES [death related to the abuse of medicines] in strong collaboration with toxicologists or such OPPIDUM [observation of illegal products and misuse of psychotropic medications]), complementary to the spontaneous reporting. A such multidimensional approach including proactive surveillance by these tools and also among several heterogenous data sources (such as data from hospitals or claims database) is able to detect early addictovigilance signals and warnings as illustrated with three following examples: cannabis use and acute serious cardiovascular disorders, new synthetic opioids (ocfentanil, carfentanil) and severe opiate overdose or deaths, the diverted use of psychoactive drugs (codeine analgesics or sedative H1 antihistamines called purple drank) by adolescents and young adults. The choice of a broad strategy and the multifaceted system implemented by the French Addictovigilance Network using elements of pharmacology (fundamental, clinical, pharmacoepidemiology) expertise is an innovative method to detect early addictovigilance signals, and to describe its characteristics in order to increase awareness of psychoactive substances by patients, users and health professionals.
Collapse
Affiliation(s)
- Joëlle Micallef
- UMR 1106, Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Marseille, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, Aix-Marseille université, 13005 Marseille, France.
| | - Émilie Jouanjus
- UMR 1027 Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Toulouse, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, université Paul-Sabatier, 31000 Toulouse, France
| | - Michel Mallaret
- Centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, centre hospitalo-universitaire de Grenoble, 38043 Grenoble, France
| | - Maryse Lapeyre Mestre
- UMR 1027 Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Toulouse, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, université Paul-Sabatier, 31000 Toulouse, France
| |
Collapse
|
5
|
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]
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Carton L, Dondaine T, Deheul S, Marquié C, Brigadeau F, Amad A, Devos D, Danel T, Bordet R, Cottencin O, Gautier S, Ménard O. Prescriptions hors AMM supervisées de méthylphénidate dans le TDAH de l’adulte. Encephale 2019; 45:74-81. [DOI: 10.1016/j.encep.2018.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
|
8
|
Pauly V, Frauger E, Lepelley M, Mallaret M, Micallef J. Profils d’exposition au méthylphénidate à l’âge adulte. Therapie 2018. [DOI: 10.1016/j.therap.2018.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
9
|
Pauly V, Frauger E, Lepelley M, Mallaret M, Boucherie Q, Micallef J. Reply to 'Overuse or underuse of methylphenidate in adults in France: commentary on Pauly et al. 2018' by Weibel et al. Br J Clin Pharmacol 2018; 85:275-276. [PMID: 30421494 DOI: 10.1111/bcp.13776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/30/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vanessa Pauly
- Laboratoire de santé publique EA 3279, CEReSS-Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie, Centre d'évaluation de la pharmacodépendance-addictovigilance (CEIP-A) de Marseille (PACA Corse) associé, Faculté de médecine, Aix-Marseille Université, Marseille, France
| | - Elisabeth Frauger
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP-addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Marion Lepelley
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, Grenoble, France
| | - Michel Mallaret
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, Grenoble, France
| | - Quentin Boucherie
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP-addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Joelle Micallef
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP-addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| |
Collapse
|
10
|
Carton L, Cabé N, Ménard O, Deheul S, Caous AS, Devos D, Cottencin O, Bordet R. Pharmaceutical cognitive doping in students: A chimeric way to get-a-head? Therapie 2018; 73:331-339. [PMID: 29625706 DOI: 10.1016/j.therap.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
For students, the pressing demands for memorization, top-level performance, and peer competition create an environment favorable for pharmaceutical cognitive doping behavior. We aimed to describe recent practices and the benefit/risk ratio of such behavior and to discuss the issues at stake. The prevalence of pharmaceutical cognitive doping among students has been reported from 1.3% to 33% across studies, with variations depending on country and definition of pharmaceutical cognitive doping. The therapeutic classes most frequently cited as being diverted for doping purposes are psychostimulants and nootropics (methylphenidate, modafinil, piracetam), corticosteroids, sedative drugs and beta-blockers. Some illegal substances such as cannabis, amphetamines and cocaine are also consumed in order to boost mental function. Finally, over-the-counter products, such as caffeine-based tablets or energy drinks, or alcohol, are also widely used by students whose motivations involve enhanced performance, concentration, memory, and staying awake during the revision and exam period. However, the expected (often fantasized) effectiveness of these products does not correspond to the reality of a modest controversial impact on cognitive performance. There appears to be an emerging profile of the student more inclined to doping behavior. Cognitive doping thus raises the question of its regulation, opening a debate opposing, on one hand, individual freedom and supposed collective benefits and, on the other hand, health consequences, educational (in)equality, and the risk of tarnished academic success. Strengthening school and university medicine, through prevention campaigns and the identification of subjects at risk, is essential to limit the extent, risk, and damages associated with such practices.
Collapse
Affiliation(s)
- Louise Carton
- Inserm, UMR S1171, service de pharmacologie médicale, CHU de Lille, université de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France; Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France.
| | - Nicolas Cabé
- Inserm, U1077, Unicaen, EPHE, neuropsychologie et imagerie de la mémoire humaine, PSL research university, CHU de Caen, Normandie université, 14000 Caen, France; Service universitaire d'addictologie, CHU de Caen, 14000 Caen, France
| | - Olivier Ménard
- Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France
| | - Sylvie Deheul
- Inserm, UMR S1171, service de pharmacologie médicale, CHU de Lille, université de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| | - Anne-Sylvie Caous
- CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| | - David Devos
- Inserm, UMR S1171, service de pharmacologie médicale, CHU de Lille, université de Lille, 59000 Lille, France; Licend Coen Center Lille, 59045 Lille, France
| | - Olivier Cottencin
- CNRS UMR 9193 SCALab PsyCHIC Team, université de Lille, 59045 Lille, France; Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France
| | - Régis Bordet
- Inserm, UMR S1171, service de pharmacologie médicale, CHU de Lille, université de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| |
Collapse
|
11
|
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.
Collapse
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.
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Pauly V, Frauger E, Lepelley M, Mallaret M, Boucherie Q, Micallef J. Patterns and profiles of methylphenidate use both in children and adults. Br J Clin Pharmacol 2018; 84:1215-1227. [PMID: 29512177 DOI: 10.1111/bcp.13544] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 12/16/2022] Open
Abstract
AIM The aim of the present study was to characterize patterns of use of methylphenidate (MPH), a prescription stimulant medication recommended in the treatment of attention deficit hyperactivity disorder (ADHD) and of narcolepsy, in France, both in children and adults, over a 3-year period. METHODS Using the French General Health Insurance database, limited to two areas covering approximately 4 million individuals, we made up a cohort of incident MPH users between July 2010 and June 2013. Splitting them into distinct age groups (18-24, 25-49 and ≥50 years of age for adults and <6, 6-11 and 12-17 years of age for children), we established the characteristics of these populations at MPH initiation and during follow-up according to the duration of treatment, quantities dispensed and coprescription with central nervous system (CNS) drugs. RESULTS We included a cohort of 3534 incident users, involving 30 238 dispensings of MPH, leading to an annual rate of 29 incident users per 100 000 in 2013. Children (66% of new users) were characterized by long-term use of MPH with few comedications. The group of 25-49-year-old patients were dispensed MPH more frequently than other groups, had the highest mean dose and were more often coprescribed other CNS drugs. The ≥50 year-old group was more often coprescribed antidepressants and antiparkinsonian drugs. CONCLUSIONS Our pharmacoepidemiological study involving incident MPH users with a large number of characteristics showed different patterns of MPH use among children and adults. The results from the 25-49-year-old group suggested that MPH might be being used for medical conditions other than ADHD or narcolepsy in adults, and that it might be subject to misuse and/or abuse.
Collapse
Affiliation(s)
- Vanessa Pauly
- Laboratoire de santé publique EA 3279, Centre d'évaluation de la pharmacodépendance-addictovigilance (CEIP-A) de Marseille (PACA Corse) associé, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Elisabeth Frauger
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
| | - Magalie Lepelley
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, 38043, Grenoble, France
| | - Michel Mallaret
- Centre d'Addictovigilance (CEIP) de Grenoble, Pavillon E CHU, 38043, Grenoble, France
| | - Quentin Boucherie
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
| | - Joëlle Micallef
- Service de pharmacologie clinique et pharmacovigilance, CNRS, CEIP - addictovigilance PACA Corse, INSERM 1106, Institut des neurosciences des systemes, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille université, 13385, Marseille, France
| |
Collapse
|
14
|
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.
Collapse
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
| | | |
Collapse
|
15
|
Carton L, Cabé N, Ménard O, Deheul S, Caous AS, Devos D, Cottencin O, Bordet R. [Pharmaceutical cognitive doping in students: a chimeric way to get-a-head?]. Therapie 2017; 73:319-329. [PMID: 29224920 DOI: 10.1016/j.therap.2017.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/04/2017] [Accepted: 10/24/2017] [Indexed: 11/27/2022]
Abstract
For students, the pressing demands for memorization, top-level performance, and peer competition create an environment favorable for pharmaceutical cognitive doping behavior. We aimed to describe recent practices and the benefit / risk ratio of such behavior and to discuss the issues at stake. The prevalence of pharmaceutical cognitive doping among students has been reported from 1.3% to 33% across studies, with variations depending on country and definition of pharmaceutical cognitive doping. The therapeutic classes most frequently cited as being diverted for doping purposes are psychostimulants and nootropics (methylphenidate, modafinil, piracetam), corticosteroids, sedative drugs and beta-blockers. Some illegal substances such as cannabis, amphetamines and cocaine are also consumed in order to boost mental function. Finally, over-the-counter products, such as caffeine-based tablets or energy drinks, or alcohol, are also widely used by students whose motivations involve enhanced performance, concentration, memory, and staying awake during the revision and exam period. However, the expected (often fantasized) effectiveness of these products does not correspond to the reality of a modest controversial impact on cognitive performance. There appears to be an emerging profile of the student more inclined to doping behavior. Cognitive doping thus raises the question of its regulation, opening a debate opposing, on one hand, individual freedom and supposed collective benefits and, on the other hand, health consequences, educational (in)equality, and the risk of tarnished academic success. Strengthening school and university medicine, through prevention campaigns and the identification of subjects at risk, is essential to limit the extent, risk, and damages associated with such practices.
Collapse
Affiliation(s)
- Louise Carton
- Inserm, UMR S1171, service de pharmacologie médicale, université de Lille, CHU de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France; Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France.
| | - Nicolas Cabé
- Inserm, U1077, Unicaen, EPHE, neuropsychologie et imagerie de la mémoire humaine, PSL research university, Normandie université, CHU de Caen, 14000 Caen, France; Service universitaire d'addictologie, CHU de Caen, 14000 Caen, France
| | - Olivier Ménard
- Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France
| | - Sylvie Deheul
- Inserm, UMR S1171, service de pharmacologie médicale, université de Lille, CHU de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| | - Anne-Sylvie Caous
- CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| | - David Devos
- Inserm, UMR S1171, service de pharmacologie médicale, université de Lille, CHU de Lille, 59000 Lille, France; Licend Coen Center Lille, 59045 Lille, France
| | - Olivier Cottencin
- CNRS UMR 9193 SCALab PsyCHIC Team, université de Lille, 59045 Lille, France; Service d'addictologie et de psychiatrie, CHU de Lille, 59037 Lille, France
| | - Régis Bordet
- Inserm, UMR S1171, service de pharmacologie médicale, université de Lille, CHU de Lille, 59000 Lille, France; CEIP-addictovigilance, service de pharmacologie médicale, CHRU de Lille, 59045 Lille cedex, France
| |
Collapse
|
16
|
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]
|
17
|
Comment on: "Social Media Mining for Toxicovigilance: Automatic Monitoring of Prescription Medication Abuse from Twitter". Drug Saf 2017; 40:183-185. [DOI: 10.1007/s40264-016-0497-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
18
|
Vérité F, Micallef J. [Acute psychiatric symptoms during methylphenidate intravenous injections: A case report]. Therapie 2016; 72:367-372. [PMID: 27988038 DOI: 10.1016/j.therap.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/04/2016] [Accepted: 10/13/2016] [Indexed: 11/24/2022]
Abstract
We report the case of a 32-year-old man who developed acute psychiatric disorders after repeated intravenous injections of methylphenidate. The behavioural disorders with extreme psychomotor restlessness and delirious syndrome have resolved within 24hours. The available data highlight the fact that the prescriptions of methylphenidate, an amphetamine-like substance, are constantly increasing in Europe and Northern America. The potential of abuse and addiction to this drug, which is growingly misused, is now clearly established. The medical professionals should be cautious and attentive to the risk of misuse of this drug.
Collapse
Affiliation(s)
- Fabrice Vérité
- EPSM de la Sarthe, unité d'accueil et d'orientation, 20, avenue du 19-Mars-1962, 72700 Allonnes, France.
| | - Joëlle Micallef
- Service de pharmacologie, CEIP-addictovigilance PACA Corse, INT, institut des neurosciences Timone, Aix-Marseille université, CNRS, CHU Timone, AP-HM, 13385 Marseille, France
| |
Collapse
|
19
|
Daveluy A, Frauger E, Peyrière H, Moracchini C, Haramburu F, Micallef J. Which psychoactive substances are used by patients seen in the healthcare system in French overseas territories? Results of the OPPIDUM survey. Fundam Clin Pharmacol 2016; 31:126-131. [DOI: 10.1111/fcp.12233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/21/2016] [Accepted: 08/30/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Amélie Daveluy
- CHU Bordeaux; Service de Pharmacologie médicale; Centre d'Addictovigilance; INSERM U1219; F-33000 Bordeaux France
| | - Elisabeth Frauger
- CNRS; INT, Institut de Neurosciences Timone; APHM; Service de Pharmacologie Clinique; Centre d'Addictovigilance Paca Corse; Aix Marseille Université; F-13005 Marseille France
| | - Hélène Peyrière
- Département de Pharmacologie médicale et Toxicologie; Centre d'Addictovigilance; CHRU Montpellier; F-34295 Montpellier France
| | - Christophe Moracchini
- CNRS; INT, Institut de Neurosciences Timone; APHM; Service de Pharmacologie Clinique; Centre d'Addictovigilance Paca Corse; Aix Marseille Université; F-13005 Marseille France
| | - Françoise Haramburu
- CHU Bordeaux; Service de Pharmacologie médicale; Centre d'Addictovigilance; INSERM U1219; F-33000 Bordeaux France
| | - Joëlle Micallef
- CNRS; INT, Institut de Neurosciences Timone; APHM; Service de Pharmacologie Clinique; Centre d'Addictovigilance Paca Corse; Aix Marseille Université; F-13005 Marseille France
| |
Collapse
|
20
|
Schifano F, Papanti GD, Orsolini L, Corkery JM. The consequences of drug misuse on post-marketing surveillance. Expert Rev Clin Pharmacol 2016; 9:867-71. [PMID: 27095119 DOI: 10.1080/17512433.2016.1178571] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Fabrizio Schifano
- a Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences , University of Hertfordshire , Hatfield , UK
| | - Gabriele Duccio Papanti
- a Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences , University of Hertfordshire , Hatfield , UK
| | - Laura Orsolini
- a Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences , University of Hertfordshire , Hatfield , UK
| | - John Martin Corkery
- a Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences , University of Hertfordshire , Hatfield , UK
| |
Collapse
|
21
|
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]
|
22
|
Lapeyre-Mestre M, Dupui M. Système de surveillance en addictovigilance : quelles données pharmacoépidémiologiques à l'échelle de l'Europe ? Therapie 2015. [DOI: 10.2515/therapie/2015006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|