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.

[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).

Parachuting psychoactive substances: Pharmacokinetic clues for harm reduction.

BACKGROUND: Parachuting, also called bombing, is a way to ingest psychoactive substances wrapped into cigarette paper, toilet paper, etc. There is little data describing parachuting in terms of substances use, context of use and, most importantly, the motivations for using such wrappers, although some authors hypothesized that parachute could be used for pharmacokinetic reason. However, inconsistently, some authors report that parachutes are used for sustained-release whereas others report that users are looking for an immediate effect. RESEARCH DESIGN AND METHODS: Considering parachute as a "home-made" dosage form, we have applied the dissolution testing to characterize the dissolution performance of a substance wrapped into a parachute and to characterize whether a parachute represents an immediate-release form or not. RESULTS: This in-vitro study provides the first pharmacokinetic data for drugs wrapped in parachutes. It shows that parachute acts as sustained-release form when made with a cigarette paper wrapper, but as immediate release form in the presence of alcohol or if wrapped with toilet paper. CONCLUSIONS: An important message to harm reduction is that users must be aware that a parachute can have unexpected pharmacokinetics and have to avoid taking another parachute in the absence of an immediate-effect to avoid overdose.

[Charter of medicines promotion and rational use by physicians]. / Charte de la visite médicale et bon usage du médicament.

The charter of medicines promotion recently adopted by France intends to constrain information given by sales representatives to the field of good prescription practices. Over a 11 year period (1994 to end 2004), 362 interdictions of promotional supports have been decided by the director of the French Medicines Agency. This accounts for 0.5% of the about 80 800 promotional supports controlled during this period. A date base shows the representation of the justifications of these interdictions and the predominance of documentation given or showed to the physicians. A challenge for health authorities would be to assess the actual impact of ethical and non ethical promotion.

[Orphan drugs in France (2001-2005): access to information and characteristics]. / Les médicaments orphelins commercialisés en France (2001-2005): information officielle et spécificités.

In year 2000, two european regulations have been adopted in order to increase the availability of orphan drugs in the European Union. To describe the current orphan drug market in France, a cross sectional analysis was conducted, five years later, taking account of publicly available informations, including designation, registration, reimbursement. These informations are mostly available on the Internet. Eighteen orphan drugs were marketed in France in November 2005, with restricted prescription and dispensing conditions. Four of them were available before registration for compassional use. Eight will be reassessed soon, with complementary data requested by health authorities. Informations about orphan drugs are scattered on different French or European websites, which complicate access for health professionals. The opinions of "Commission de Transparence", which assess utility of drugs, give some precisions for each orphan drug (prevalence of the disease, therapeutic alternative, etc.).

Medicines submitted to narcotics regulations in France, 1992-2007.

The objective was to study the current narcotics regulations which are the most restrictive regarding prescription and dispensation practice in France, and their evolution over the period 1992-2007. This is an example of regulation in a European member state regarding medicines with a risk of abuse or dependence. Narcotics regulations were studied in the French public health code. Status and indications of medicines concerned were found on the French medicine agency website, and the retrospective part of the study was conducted using the French public statute law website. Seventeen medicines were found. Three were psychotropics and fourteen narcotics. The prescription rules could be different for a given substance according to the route of administration or indication. In 2007, half of the narcotic opioids could be prescribed for 28 days, whereas in 1992, most of them could be prescribed for only 7 days. These results show the adaptation of French narcotics regulations, with the development of medicines indicated in acute or chronic pain treatment or opioid maintenance treatment.