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Aquizerate A, Laforgue EJ, Istvan M, Rousselet M, Gerardin M, Jouanjus E, Libert F, Guerlais M, Victorri-Vigneau C. French national addictovigilance follow-up of zolpidem between 2014 and 2020: evolution of drug abuse, misuse and dependence before and after the regulatory change. Eur J Public Health 2023; 33:169-175. [PMID: 36749030 PMCID: PMC10066475 DOI: 10.1093/eurpub/ckad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Since the appearance of zolpidem on the market, the occurrence of serious cases of abuse, misuse and dependence have come to the attention of authorities. In view of the increase in the number and severity of cases among zolpidem users and the predominant presence of zolpidem in falsified prescriptions, the French Health Authorities implemented part of the narcotics regulation for zolpidem in April 2017. The objective of this article was to describe the evolution of the abuse, dependence and misuse of zolpidem. METHODS We used three data sources: (i) zolpidem is a reimbursable and strictly prescription drug in France. Medic'AM is a public database that indicates the number of tablets reimbursed each month in France for each reimbursable drug. This database has been analyzed as a proxy of the exposure of the French population to zolpidem; (ii) all French cases of drug dependence or abuse reported by health professionals (regulatory obligation) and (iii) an epidemiological tool based on the surveillance of falsified prescriptions over two periods: the 3-year period before the regulatory measure (2014-16) and the 3-year period after the regulatory measure (2018-20). RESULTS This regulatory change had two immediate consequences: a sharp decline in falsified prescriptions and a decrease of ∼57% between the two study periods in the zolpidem reimbursement data. Markers of problematic consumption remained after the regulatory change with worsening cases, particularly for people who were genuinely dependent and/or had comorbidities or misusers for whom zolpidem was the substance of interest, whose proportion increased significantly in the addictovigilance notification system, from 43.6% (N = 107) to 59.3% (N = 127) (P < 0.01). CONCLUSIONS Further monitoring is needed in light of these persistent markers of problematic consumption.
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Affiliation(s)
- Aurélie Aquizerate
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France.,Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-centered outcomes and HEalth ResEarch, SPHERE, Nantes F-44000, France
| | - Marion Istvan
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France.,Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-centered outcomes and HEalth ResEarch, SPHERE, Nantes F-44000, France
| | - Morgane Rousselet
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France.,Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-centered outcomes and HEalth ResEarch, SPHERE, Nantes F-44000, France.,Nantes Université, CHU Nantes, Service d'Addictologie et de Psychiatrie de Liaison, Nantes, France
| | - Marie Gerardin
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France
| | - Emilie Jouanjus
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse
| | - Frédéric Libert
- Service de Pharmacologie Médicale, Université Clermont Auvergne, Centre Hospitalier Universitaire de Clermont-Ferrand
| | | | - Marylène Guerlais
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique - Centre d'Evaluation et d'Information sur la Pharmacovigilance-Addictovigilance, Nantes, France.,Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patient-centered outcomes and HEalth ResEarch, SPHERE, Nantes F-44000, France
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Laforgue EJ, Rousselet M, Claudon A, Aquizerate A, Jolliet P, Istvan M, Victorri-Vigneau C. Did the New French Regulation of Zolpidem Decrease the Problematic Consumption of Zolpidem? A Field Study among Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158920. [PMID: 35897285 PMCID: PMC9331950 DOI: 10.3390/ijerph19158920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 12/03/2022]
Abstract
Background: The French national drug regulatory authority stated, in 2017, that a secured prescription pad must be used for zolpidem prescriptions. This study aimed to evaluate the evolution of the problematic consumption of zolpidem at the individual level since the new regulation. Methods: Two nationwide populations of at-risk users of zolpidem were recruited: one in general practitioner (GP) offices and one in specialized care centers dedicated to drug dependence (SCDDs). Participants were asked about their zolpidem consumption before and after the regulation change. The primary outcome was the evolution of problematic zolpidem consumption, as defined by at least one of the following criteria: overconsumption, fraudulent ways of obtaining, effects sought other than hypnotic, and modes of administration other than oral. Results: A total of 243 participants were included: 125 from GP offices and 118 from SCDDs. In the GP population, the prevalence of patients who were identified as problematic consumers decreased from 24.8% to 20.8% (p = 0.593), whereas the prevalence decreased from 73.7% to 51.7% in the SCDD population (p < 0.001). The most prevalent criteria for problematic status were overconsumption and fraudulent ways. Conclusions: The new French regulation of zolpidem had different impacts among two different populations of at-risk zolpidem consumers.
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Affiliation(s)
- Edouard-Jules Laforgue
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
- Correspondence: ; Tel.: +33-2–4008-4073
| | - Morgane Rousselet
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, F-44000 Nantes, France
| | - Antoine Claudon
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
| | - Aurélie Aquizerate
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
| | - Pascale Jolliet
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
| | - Marion Istvan
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
| | - Caroline Victorri-Vigneau
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
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