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Underner M, Perriot J, Peiffer G, Brousse G, Jaafari N. [Bronchial diseases and heroin use. A systematic review]. Rev Mal Respir 2023; 40:783-809. [PMID: 37925326 DOI: 10.1016/j.rmr.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/11/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION Heroin use can cause respiratory complications including asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis (BD). OBJECTIVES A general review of the literature presenting the data on the relationships between heroin consumption and bronchial complications, while underlining the difficulties of diagnosis and management. DOCUMENTARY SOURCES Medline, 1980-2022, keywords "asthma" or "bronchospasm" or "COPD" or "bronchiectasis" and "heroin" or "opiate" or "opiates", with limits pertaining to "Title/Abstract". Concerning asthma, 26 studies were included, as were 16 for COPD and 5 for BD. RESULTS Asthma and COPD are more prevalent among heroin addicts, who are less compliant than other patients with their treatment. The authors found a positive association between frequency of asthma exacerbations, admission to intensive care and heroin inhalation. Late diagnosis of COPD worsens the course of the disease; emphysema and BD are poor prognostic factors. CONCLUSION Bronchial diseases in heroin users can be identified by means of respiratory function exploration and chest CT scans. These tests should be performed frequently in view of optimizing their care, which includes their weaning themselves from addictive substances.
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Affiliation(s)
- M Underner
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - J Perriot
- Dispensaire Émile-Roux, CLAT, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - G Brousse
- Service d'addictologie, CHU de Clermont-Ferrand, université Clermont Auvergne, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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Fresnaye J, Le Pennec A, Fouques C, Gesnouin P, Grimley M, Auclair V, Prevost V. [Development of a targeted educational activity in addictology: From design to use in specialized structures in the Normandy region]. Therapie 2023:S0040-5957(23)00145-2. [PMID: 37973493 DOI: 10.1016/j.therap.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Risk and damage reduction is a public health issue and allows to consider addiction as a chronic pathology in which patients have the opportunity to become actors of their own care, a philosophy shared with Therapeutic Education. In this context, our objective is to develop a tool adapted to the populations of patients/users in specialized structures, meeting the criteria of a Targeted Educational Activity, to allow them a better understanding and management of their addiction to opiates on a daily basis. METHOD In a multi-professional setting, involving pharmacists, doctors and nurses, an exploratory phase was conducted in order to identify the theme, the target population and the tool format. Then, the tool was built and validated with the ambition of responding pedagogically to the problems encountered daily by patients/users. RESULTS The pedagogical tool, called "Le QUIZZ à moindre risque", contains 51 questions categorized in 2 structured parts on the reduction of risks related to opiate consumption and substitution drugs. Focused on the problems of patients/users, it helps them achieve greater autonomy in their health and a better quality of life, with and despite the illness. The proposed format makes it a tool that can be freely consulted by patients/users according to their practices and needs; it can also be used in group workshops conducted with the caregivers. CONCLUSION The tool developed aims to (i) enable opiate users to acquire skills to improve the management of their consumption and the risks involved and (ii) strengthen communication between patients/users and caregivers by offering them the opportunity to be actors of their care. The tool is currently being tested and evaluated in many cities in Normandy and its optimization will allow for an improvement in care that meets the challenges and needs.
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Affiliation(s)
- Julie Fresnaye
- Faculté des sciences pharmaceutiques, UFR santé, Normandie Université Caen, 14000 Caen, France.
| | - Annaïg Le Pennec
- Centre de soins d'accompagnement et de prévention en addictologie (CSAPA), établissement public de santé mentale, 14000 Caen, France; Centre d'accueil et d'accompagnement à la réduction des risques pour usagers de drogues (CAARUD), établissement public de santé mentale, 14000 Caen, France
| | - Christophe Fouques
- Centre d'accueil et d'accompagnement à la réduction des risques pour usagers de drogues (CAARUD), établissement public de santé mentale, 14000 Caen, France
| | - Pierre Gesnouin
- Centre de soins d'accompagnement et de prévention en addictologie (CSAPA), établissement public de santé mentale, 14000 Caen, France
| | - Matthew Grimley
- Centre de soins d'accompagnement et de prévention en addictologie (CSAPA), établissement public de santé mentale, 14000 Caen, France
| | - Valérie Auclair
- Pharmacie à usage intérieur, établissement public de santé mentale, 14000 Caen, France
| | - Virginie Prevost
- UNICAEN, Inserm U1086, ANTICIPE, Normandie université, 14000 Caen, France
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Abstract
INTRODUCTION The use of cannabis, cocaine or heroin can be responsible for many respiratory complications including asthma. OBJECTIVES The aim of this systematic literature review of data was to expose the relations between cannabis, cocaine or heroin use and asthma. RESULTS Cannabis, cocaine or heroin use by inhalation may be responsible for respiratory symptoms (cough, wheezing), asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or deaths related to asthma. Lower adherence to asthma treatment is also observed. Cannabis induces a rapid bronchodilator effect. In contrast, its chronic use may induce a decrease in specific airway conductance. Studies on forced expiratory volume in one second (FEV1) reduction or decline are discordant. CONCLUSION Cannabis, cocaine or heroin use must be considered in cases of acute respiratory symptoms or asthma exacerbation in young persons and practitioners must help illicit substance users to stop their consumption.
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Affiliation(s)
- M Underner
- Consultation de tabacologie, unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - J Perriot
- Dispensaire Émile-Roux, CLAT 63, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Consultation de tabacologie, unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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Chappuy M, Trojak B, Nubukpo P, Bachellier J, Bendimerad P, Brousse G, Rolland B. [Prolonged-release buprenorphine formulations: Perspectives for clinical practice]. Therapie 2020:S0040-5957(20)30098-6. [PMID: 32493637 DOI: 10.1016/j.therap.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/06/2020] [Indexed: 12/22/2022]
Abstract
Buprenorphine and methadone are the two main opioids agonist treatments approved for opioid use disorder. Buprenorphine is a partial agonist of the mu-opioid receptors, which has been merely available through sublingual form until now. In practice, the use of buprenorphine is smoother than that of methadone, and it induces reduced risks of overdose. However, sublingual buprenorphine also exposes to risks (e.g., withdrawal, misuse) and constraints (e.g., daily intake). Three new galenic formulations of prolonged-release buprenorphine (PRB) are being commercialized and should allow some improvements in patients' comfort and safety. This narrative review aims to describe the main technical features and efficacy and safety data of these PRBs, as well as patients' and professionals' expectancies and concerns, using data of the scientific literature and the regulatory texts. PRBs consist of one subcutaneous implant and two subcutaneous injection depots. Sixmo®/Probuphine® is a six-month-long implant which needs to be surgically placed and removed and is approved for subjects previously treated with a maximum daily dose of 8mg of sublingual buprenorphine, and can be used only for two successive periods of six months before the subject needs to be switched back to sublingual form. Sublocade® is a one-month-long depot formulation that is indicated in switch from sublingual buprenorphine, and which proposes only two dose schemes, i.e., 100 and 300mg monthly. Buvidal®/Brixadi® is a one-week- or one-month-long depot formulation with multiple dosages, which can be used in initiation or in switched from sublingual formulations. While opioid users report some concerns with a risk of coercive use of long-acting forms of buprenorphine, both users and professionals deem that these new specialties could be particularly appreciated in stabilized patients bothered with the daily intake of the treatments, or specific situations at risk of treatment dropout (e.g., following hospital discharge or prison release).
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Affiliation(s)
- Mathieu Chappuy
- Service universitaire d'addictologie de Lyon (SUAL), centre hospitalier Le Vinatier, 95, boulevard Pinel, 69678 Bron, France; Service d'addictologie, groupement hospitalier centre, hospices civils de Lyon, 69003 Lyon, France; Centre de soins, d'accompagnement et de prévention en addictologie, groupement hospitalier nord, hospices civils de Lyon, 69004 Lyon, France.
| | - Benoit Trojak
- Service hospitalo-universitaire d'addictologie, CHU de Dijon, 21079 Dijon, France; Inserm U1093 cognition, action et plasticité sensorimotrice, UFR staps, université de Bourgogne Franche Comté, 21078 Dijon, France
| | - Philippe Nubukpo
- Service universitaire d'addictologie, centre hospitalier Esquirol, 87000 Limoges, France; Inserm UMR 1094 neuroépidémiologie tropicale, université de Limoges, 87000 Limoges, France
| | - Jérôme Bachellier
- Service universitaire d'addictologie de Tours, CHU Bretonneau, 37000 Tours, France
| | - Patrick Bendimerad
- Service d'addictologie, groupe hospitalier de La Rochelle-Ré-Aunis, 17000 La Rochelle, France; Service de psychiatrie, groupe hospitalier de La Rochelle-Ré-Aunis, 17000 La Rochelle, France
| | - Georges Brousse
- Service de psychiatrie B et d'addictologie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Équipe d'accueil 7280, unité de formation et de recherche de médecine, université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Rolland
- Service universitaire d'addictologie de Lyon (SUAL), centre hospitalier Le Vinatier, 95, boulevard Pinel, 69678 Bron, France; Service d'addictologie, groupement hospitalier centre, hospices civils de Lyon, 69003 Lyon, France; Inserm, Inserm U1028, CNRS UMR 5292, CRNL, UCBL1, université de Lyon, 69500 Bron, France
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Lenglard F, Berger-Vergiat A, Ragonnet D, Duvernay N, Lack P, Poulet E, Zoulim F, Chappuy M. [Feedback from two French addiction centers and national survey on the intranasal naloxone (Nalscue ®) in the prevention of opioid overdoses]. Therapie 2019; 74:477-486. [PMID: 30792078 DOI: 10.1016/j.therap.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/18/2018] [Accepted: 01/17/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE France has temporarily authorized addictology centers to use a form of intranasal naloxone (Nalscue®) to prevent opioid overdoses. The objectives of this work are to present both the characteristics of the patients included in this device in two hospitals centers and the results of the national survey on addiction center's contribution to this new risk reduction tool. METHODS Patient data are those requested under Nalscue® study (inclusion period July 2016 to January 2018). The survey is an online questionnaire distributed to all addiction centers with an email address. RESULTS Over this period, in the two addiction centers, 370 kits (35% of the national total) were distributed to 330 patients including 312 opioid users. Of these users, 15% report injecting and 85% are poly-consumers. In 14% of the cases, a patient's relative was formed to administrate the Nalscue®. Forty kits (30 given away, 6 lost, 4 administered) were renewed to 35 users. Of the 462 addiction centers contacted, 82 (18%) responded. Among 76 structures specialized in opioid addictions, two did not feel concerned and one had no knowledge of the antidote. Fifty-five structures were formed by the pharmaceutical firm. Nine hundred forty-seven patients (58% of the total) were included by 37 centers. Forty-four centers ordered 2458 kits and dispensed 1116 (including kits given out of study). Thirteen structures reported use of Nalscue®. CONCLUSION The interest of intranasal naloxone is no longer to be demonstrated in a context of opioid overdose, but the preauthorized framework did not allow a major diffusion of the antidote within the population most at risk. Let us hope that the availability in pharmacy can promote its distribution and thus reduce the number of deaths.
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Affiliation(s)
- Flavy Lenglard
- Institut des sciences pharmaceutiques et biologiques de Lyon, 69008 Lyon, France; Service pharmaceutique, groupement hospitalier Centre, hospices civils de Lyon, 69003 Lyon, France
| | - Aurélie Berger-Vergiat
- Service d'addictologie, centre de soins, d'accompagnement et de prévention en addictologie, groupement hospitalier Centre, hospices civils de Lyon, 69003 Lyon, France
| | - Delphine Ragonnet
- Service d'addictologie, centre de soins, d'accompagnement et de prévention en addictologie, groupement hospitalier Centre, hospices civils de Lyon, 69003 Lyon, France
| | - Nathalie Duvernay
- Centre de soins, d'accompagnement et de prévention en addictologie, groupement hospitalier Nord, hospices civils de Lyon, 69004 Lyon, France
| | - Philippe Lack
- Centre de soins, d'accompagnement et de prévention en addictologie, groupement hospitalier Nord, hospices civils de Lyon, 69004 Lyon, France
| | - Emmanuel Poulet
- Service de psychiatrie, groupement hospitalier Centre, hospices civils de Lyon, 69003 Lyon, France
| | - Fabien Zoulim
- Service d'hépatologie et gastro-entérologie, groupement hospitalier Nord, hospices civils de Lyon, 69004 Lyon, France
| | - Mathieu Chappuy
- Service pharmaceutique, groupement hospitalier Centre, hospices civils de Lyon, 69003 Lyon, France; Service d'addictologie, centre de soins, d'accompagnement et de prévention en addictologie, groupement hospitalier Centre, hospices civils de Lyon, 69003 Lyon, France; Centre de soins, d'accompagnement et de prévention en addictologie, groupement hospitalier Nord, hospices civils de Lyon, 69004 Lyon, France; Service pharmaceutique, groupement hospitalier Nord, hospices civils de Lyon, 69004 Lyon, France.
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