A 13-Year National Monitoring Study to Assess Narcotic Prescriptions and Indications (2007-2019).

INTRODUCTION: Analgesics are among the most widely used drugs worldwide. This study describes the population treated with narcotic analgesics, their therapeutic indications and how the data have evolved over a decade. METHODS: A cross-sectional, national, multicentre survey study was conducted that included surveys taken every year from 2007 to 2019 in a national sample of 1500 randomly selected dispensing pharmacies. RESULTS: The mean age of patients, mostly women (around 60%), remained stable over the study period (63.2 ± 17.1 years in 2007, 68.2 ± 17.2 years in 2019). The proportion of patients treated for more than 3 months increased from 2007 to 2019. Most prescriptions involved morphine, oxycodone and fentanyl (98.5% of all prescriptions in 2019). Morphine prescriptions dropped dramatically from 49.6% (2007) to 32.3% (2019) of the total narcotic analgesics. Fentanyl prescriptions varied from 40.1% in 2007 to 32.2% in 2019. Prescriptions of oxycodone, regardless of the indication, increased steadily from 2007, from 8.3 to 34% in 2019, becoming the most prescribed narcotic analgesic for the first time since the beginning of the survey. CONCLUSIONS: This study demonstrates how narcotic opioids are prescribed, thanks to the active participation of health professionals, and confirms the striking increase in the prescription of oxycodone.

Establishment of the medico-legal cause of death in two atypical cases of gas embolism in hospital: Importance of the scene.

Two cases of lethal gas embolism occurring in a hospital setting are presented. These did not differ with regards to the medical cause of death (MCOD), but did so with regard to the medico-legal cause of death (MLCOD). In the first case, the immediate recognition of a suspicious death and subsequent conservation of the scene led to a certain MLCOD (autolysis). In the second case, the death was initially treated as of natural cause. The subsequent disruption of the scene of death led to loss of evidence essential to establish the MLCOD, that was concluded to be undetermined. These cases illustrate the importance of medico-legal treatment of scenes of death to arrive at the MLCOD, and that the hospital setting is no exception especially as in view of potential medical liability.