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.

[Community pharmacists, students in pharmacy, and requests of codeine-based medicines: Observational study]. / Pharmaciens d'officine, étudiants en pharmacie et demandes de médicaments à base de codéine : étude observationnelle.

INTRODUCTION: The case of purple drank motivated a study to investigate the way community pharmacists and students in pharmacy managed, with patients, the abuse risk of non-prescription codeine-based medicines. METHODS: This prospective descriptive study was conducted, between September and October 2016, within a 170 community pharmacies network of Aquitaine and 437 pharmacy students of Bordeaux university (fourth, fifth and sixth year students, without selection of the pharmacies where they were able to work). It used a common survey questionnaire, which was sent to students through their own "Facebook" (Facebook Inc.) groups. RESULTS: Pharmacists advised codeine-based medicines in self-medication mostly as a second line pain treatment (96.2%), students also (72.1%). The opinions of pharmacists were almost equally shared concerning their ability to identify dependent patients or to raise the subject of addiction with them (57.7% and 53.8% of positive responses). This seemed to be more difficult for students (57.4% doubted about their ability of identification, 73.8% felt unable to address this issue with patients). Successful experiences concerning help to pharmacodependent patients were rare (11.5% of pharmacist, 4.9% of students). All were involved in patient information on these medicines use. Their opinions about an evolution toward a mandatory prescription status for all codeine-based medicines were almost equally split: 50% of pharmacists were favourable to it, 44.3% of students. They expressed the need for information tools in the care of these patients (46.2% of community pharmacists, 63.9% of students). CONCLUSION: These results illustrated the interest of pharmacists, and students in pharmacy, toward pharmacodependent patients; they also showed the complexity of this relation. Thus, they could help the elaboration of information tools in the care of these patients, with an adaptation for students who nevertheless presented a good maturity about this question.

[French trends in the misuse of Fentanyl: From 2010 to 2015]. / Le mésusage du fentanyl en France : 2010 à 2015.

OBJECTIVES: The aim of this study was to evaluate the French use, misuse and abuse/dependence of non-injectable forms of fentanyl (transdermal and transmucosal fentanyl formulations). METHODS: Problematic use of transdermal and transmucosal fentanyl formulations was evaluated using an approach combining multiple sources of information: (1) spontaneous notifications recorded during 6 years (2010-2015) for transdermal fentanyl form and 3 years for transmucosal fentanyl forms and (2) data from annual epidemiological systematic surveys conducted by the French Addictovigilance Network during 6 years (2010-2015). RESULTS: In all, 147 cases were notified for transdermal fentanyl formulation and 109 cases for transmucosal fentanyl formulations. According to the galenic formulation, analysis of these cases emphasizes different profiles: for transdermal fentanyl formulation, two consumption profiles: 1/mainly for analgesic effects (74 %): women (61 %), 47 years, with addictive and/or psychiatric history (46 %), treated for chronic non-cancer related pain (93 %), 2/seeking positive psychic effects other than analgesia (26 %): men (82 %), 32 years, with addictive and/or psychiatric history (87 %) and having obtained the fentanyl patch illegally (60 %) for non-medical use. For transmucosal fentanyl formulations, only one consumption profile was observed: women (52 %), 48 years, with addictive (24 %) and/or psychiatric history (28 %), off label indication (72 %) (indications for non-cancer pain and/or no or insufficient opioid background treatment). The misuse of transmucosal fentanyl formulations implies a high risk of adverse effects: those already known of opioid-based drugs, sometimes lethal (withdrawal syndrome, respiratory and central nervous system depression…) but also serious reactions at the application site (buccal or nasal). For the transdermal fentanyl formulation, 27 cases (18 %) of involuntary intoxication were observed, of which 25 were serious. Nineteen deaths involving both forms of fentanyl have been reported (2 for the transmucosal formulations and 17 for the transdermal formulation). CONCLUSION: Our results report significant and worrying misuse of transmucosal fentanyl formulations with wide off-label use and also primary dependence on fentanyl, regardless of galenic formulation, in patients treated for chronic non cancer pain. Given the significant risks of fentanyl, it is necessary to continue the monitoring of misuse, in particular, thanks to the activities of the French Addictovigilance network allowing a multisource approach and who provides information concerning cases of abuse, misuse and dependence.

[From psychoactive medicines to addictovigilance in French Public Health Code (1990-2017)]. / Du médicament psychoactif à l'addictovigilance dans le Code de la santé publique en France (1990­2017).

Addictovigilance in the French Public Health Code, in the section related to poisonous substances, refers to a monitoring system developed since 1990: control of psychoactive substances and products, with medicinal use or not, was completed by a specific system focused on evaluation and information on pharmacodependance in 1999. The French medicines agency (Agence du médicament) created in 1993 was involved in this monitoring system; pharmacodependance evaluation was added by law to the missions of the agencies that followed: the Agence française de sécurité sanitaire des produits de santé missions (AFSSAPS, 1998) and the Agence nationale de sécurité du médicament et des produits de santé (ANSM, 2011). "Addictovigilance" first appears in French Law in 2017 whereas it was used by pharmacodependance centers and AFSSAPS since 2007. Legal definition of addictovigilance in the French Public Health Code testified to public authorities action against addictive behavior whatever products status, legal or not. The visibility of addictovigilance is growing on the Internet as well (ANSM website, web portal for reporting adverse health events).