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Soeiro T, Pradel V, Lapeyre-Mestre M, Micallef J. Systematic assessment of non-medical use of prescription drugs using doctor-shopping indicators: A nation-wide, repeated cross-sectional study. Addiction 2023; 118:1984-1993. [PMID: 37203878 DOI: 10.1111/add.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
AIMS The aim of this study was to present the first nation-wide, systematic, repeated assessment of doctor-shopping (i.e. visiting multiple physicians to be prescribed the same drug) during 10 years for more than 200 psychoactive prescription drugs in the 67 million inhabitants in France. DESIGN This was a nation-wide, repeated cross-sectional study. SETTING AND PARTICIPANTS Data are from the French National Health Data System in 2010, 2015 and 2019 for 214 psychoactive prescription drugs (i.e. anaesthetics, analgesics, antiepileptics, anti-Parkinson drugs, psycholeptics, psychoanaleptics, other nervous system drugs and antihistamines for systemic use). MEASUREMENTS The detection and quantification of doctor-shopping relied upon an algorithm that detects overlapping prescriptions from repeated visits to different physicians. We used two doctor-shopping indicators aggregated at population level for each drug dispensed to more than 5000 patients: (i) the quantity doctor-shopped, expressed in defined daily doses (DDD), which measures the total quantity doctor-shopped by the study population for a given drug; and (ii) the proportion doctor-shopped, expressed as a percentage, which standardizes the quantity doctor-shopped according to the use level of the drug. FINDINGS The analyses included approximately 200 million dispensings to approximately 30 million patients each year. Opioids (e.g. buprenorphine, methadone, morphine, oxycodone and fentanyl), benzodiazepines and non-benzodiazepine hypnotics (Z-drugs) (e.g. diazepam, oxazepam, zolpidem and clonazepam) had the highest proportions doctor-shopped during the study period. In most cases, the proportion and the quantity doctor-shopped increased for opioids and decreased for benzodiazepines and Z-drugs. Pregabalin had the sharpest increase in the proportion doctor-shopped (from 0.28 to 1.40%), in parallel with a sharp increase in the quantity doctor-shopped (+843%, from 0.7 to 6.6 DDD/100 000 inhabitants/day). Oxycodone had the sharpest increase in the quantity doctor-shopped (+1000%, from 0.1 to 1.1 DDD/100 000 inhabitants/day), in parallel with a sharp increase in the proportion doctor-shopped (from 0.71 to 1.41%). Detailed results for all drugs during the study period can be explored interactively at: https://soeiro.gitlab.io/megadose/. CONCLUSIONS In France, doctor-shopping occurs for many drugs from many pharmacological classes, and mainly involves opioid maintenance drugs, some opioids analgesics, some benzodiazepines and Z-drugs and pregabalin.
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, Marseille, France
- Unité de pharmacoépidémiologie, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
| | - Vincent Pradel
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
| | - Maryse Lapeyre-Mestre
- Université de Toulouse, Inserm, Toulouse, France
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, Marseille, France
- Unité de pharmacoépidémiologie, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
- Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France
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Roussin A, Soeiro T, Fouque C, Jouanjus E, Frauger E, Fouilhé N, Mallaret M, Micallef J, Lapeyre-Mestre M. Increase of high-risk tramadol use and harmful consequences in France from 2013-2018: evidence from the triangulation of addictovigilance data. Br J Clin Pharmacol 2022; 88:3789-3802. [PMID: 35318713 PMCID: PMC9545570 DOI: 10.1111/bcp.15323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 12/11/2022] Open
Abstract
Aims The aim of this paper is to assess recent developments in non‐medical tramadol use, tramadol use disorder, illegal procurement and deaths. Methods This study used repeated cross‐sectional analysis of data collected nationwide from 2013 to 2018. Analysis was conducted through multisource monitoring of the French Addictovigilance Network of: (1) validated reports of high‐risk tramadol use, (2) record systems collecting information from toxicology experts investigating analgesic‐related deaths (DTA) and deaths related to substance abuse (DRAMES), and pharmacists for forged prescriptions (OSIAP), and (3) survey of drug users, with investigation of patterns of use while visiting addiction‐specialised institutions (OPPIDUM). Results Despite a plateauing level of tramadol exposure in the French population, the proportion of tramadol reports increased 1.7‐fold (187 cases in 2018, 3.2% (95% confidence interval [CI]: 2.74–3.63%), versus 1.9% (95% CI: 1.49–2.42% in 2013). Trends were similar in OSIAP: 11.9% of forged prescriptions in 2018 (95% CI: 10.56–13.45%); 1.7‐fold increase; in OPPIDUM: 0.76% (95% CI: 0.55–1.02); 2.2‐fold increase; and DRAMES: 3.2% of drug abuse‐related deaths in 2018 (95% CI: 1.89–5.16) versus 1.7% in 2013 (95% CI: 0.65–3.84). Tramadol was the primary opioid in analgesic‐related deaths in DTA (45% in 2018). Two profiles of high‐risk tramadol users were identified: (1) patients treated for pain or with tramadol persistence when pain disappeared (mainly women; mean age 44 years), and (2) individuals with non‐medical use for psychoactive effects (mainly men; mean age 36 years). Conclusion The triangulation of the data obtained through addictovigilance monitoring evidenced a recent increase in high‐risk tramadol use. These findings have a practical impact on the limitation of the maximal duration of tramadol prescriptions.
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Affiliation(s)
- Anne Roussin
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France.,Pharmacologie en Population Cohortes et Biobanques, Centre d'Investigation Clinique 1436, Université de Toulouse, France
| | - Thomas Soeiro
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France
| | - Charlotte Fouque
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France
| | - Emilie Jouanjus
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France.,CERPOP, Université de Toulouse, INSERM, France
| | - Elisabeth Frauger
- Aix-Marseille Université, Assistance publique-Hôpitaux de Marseille, Inserm, Inst Neurosci System, UMR 1106, Service de pharmacologie clinique et Pharmacovigilance, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Marseille, France
| | - Nathalie Fouilhé
- Département de Pharmacologie Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire Grenoble Alpes, France
| | - Michel Mallaret
- Département de Pharmacologie Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire Grenoble Alpes, France
| | - Joëlle Micallef
- Aix-Marseille Université, Assistance publique-Hôpitaux de Marseille, Inserm, Inst Neurosci System, UMR 1106, Service de pharmacologie clinique et Pharmacovigilance, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Marseille, France
| | - Maryse Lapeyre-Mestre
- Département de Pharmacologie Clinique et Médicale, Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Centre Hospitalier Universitaire de Toulouse, France.,Pharmacologie en Population Cohortes et Biobanques, Centre d'Investigation Clinique 1436, Université de Toulouse, France
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Perelló M, Rio-Aige K, Guayta-Escolies R, Gascón P, Rius P, Jambrina AM, Bagaria G, Armelles M, Pérez-Cano FJ, Rabanal M. Evaluation of Medicine Abuse Trends in Community Pharmacies: The Medicine Abuse Observatory (MAO) in a Region of Southern Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7818. [PMID: 34360110 PMCID: PMC8345500 DOI: 10.3390/ijerph18157818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 01/23/2023]
Abstract
The misuse of medicines is a global public health concern that needs to be taken into consideration and requires actions across all government sectors and society. The aim of this study is to identify trends of drug abuse in Catalonia, a region of Spain located in the South of Europe. For this purpose, a questionnaire-based detection tool was created and implemented in 60 community pharmacies. Out of 548 questionnaires (98.4%), 64.2% of participants were men and the highest age proportion was 25-35 years (31.4%). Potential drug abuse was the highest in urban pharmacies (84.9%). The main drug class involved were benzodiazepines (31.8%), codeine (19.3%), tramadol (7.5%), methylphenidate (5.8%), gabapentinoids (5.8%), cycloplegic drops (4.4%), z-drugs (2.6%), piracetam (2.2%), dextromethorphan (1.6%) and clomethiazole (1.1%). The majority of drugs were requested without prescription (58.6%) and through probably forged prescriptions (23.7%). Slightly less than half (49.8%) of the patients request frequently to the pharmacist, especially in rural and mountain pharmacies (73.3% and 88.5%, respectively). A small proportion (10.8%) were requested with intimidation. Pharmacists only supplied in 21.7% of the cases. This study has demonstrated the suitability of the new detection system, being a useful approach to replicate in other locations with similar needs.
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Affiliation(s)
- Maria Perelló
- Barcelona College of Pharmacists, 08009 Barcelona, Spain; (M.P.); (G.B.)
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
| | - Karla Rio-Aige
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
- Institute of Research in Nutrition and Food Safety (INSA), 08921 Santa Coloma de Gramenet, Spain
| | - Rafel Guayta-Escolies
- Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (R.G.-E.); (P.G.)
| | - Pilar Gascón
- Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (R.G.-E.); (P.G.)
| | - Pilar Rius
- Council of the Pharmacist’s Association of Catalonia, 08009 Barcelona, Spain;
| | - Anna M. Jambrina
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain;
| | - Guillermo Bagaria
- Barcelona College of Pharmacists, 08009 Barcelona, Spain; (M.P.); (G.B.)
- Council of the Pharmacist’s Association of Catalonia, 08009 Barcelona, Spain;
| | - Mercè Armelles
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain;
| | - Francisco José Pérez-Cano
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
- Institute of Research in Nutrition and Food Safety (INSA), 08921 Santa Coloma de Gramenet, Spain
| | - Manel Rabanal
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, 08028 Barcelona, Spain; (K.R.-A.); (A.M.J.); (M.R.)
- Institute of Research in Nutrition and Food Safety (INSA), 08921 Santa Coloma de Gramenet, Spain
- Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain;
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Papazisis G, Spachos D, Siafis S, Pandria N, Deligianni E, Tsakiridis I, Goulas A. Assessment of the Safety Signal for the Abuse Potential of Pregabalin and Gabapentin Using the FAERS Database and Big Data Search Analytics. Front Psychiatry 2021; 12:640264. [PMID: 34093263 PMCID: PMC8172802 DOI: 10.3389/fpsyt.2021.640264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The latest decade, an emerging issue has been the abuse potential of the gabapentinoids pregabalin and gabapentin. The aim of our study was to assess this safety signal combining two different methods of surveillance: search analytics big data and the FDA spontaneous reporting system database. Methods: Analysis of big data and the FAERS was used to detect pregabalin's and gabapentin's abuse potential in comparison with two controls, clonazepam and levetiracetam, and further, the correlation between these domains was investigated. Data from the United States between 2007 and 2020Q2 were analyzed. Results: The FAERS analysis revealed the following pattern of signals: clonazepam > pregabalin ≥ gabapentin > levetiracetam, for both the primary term "drug abuse and dependence" and the secondary terms (withdrawal, tolerance, overdose). The Google domain pattern was slightly different: clonazepam ≥ gabapentin ≥ pregabalin≥ levetiracetam. A monotonic correlation was found between FAERS and Google searches for gabapentin (r = 0.558; p < 0.001), pregabalin (r = 0.587; p < 0.001), and clonazepam (r = 0.295; p = 0.030). Conclusion: Our results revealed that there is preliminary evidence of a safety signal for the abuse potential of pregabalin and gabapentin. Analysis of the FAERS database, supplemented by big data search analytics, suggests that there is potential of using these methods as a supplementary tool to detect drug abuse-related safety signals in pharmacovigilance.
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Affiliation(s)
- Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Spachos
- Laboratory of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Siafis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niki Pandria
- Laboratory of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Deligianni
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Goulas
- First Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lapeyre-Mestre M, Boucher A, Daveluy A, Gibaja V, Jouanjus E, Mallaret M, Peyrière H, Micallef J. Addictovigilance contribution during COVID-19 epidemic and lockdown in France. Therapie 2020; 75:343-354. [PMID: 32660776 PMCID: PMC7309935 DOI: 10.1016/j.therap.2020.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 01/16/2023]
Abstract
Addictovigilance is a safety monitoring targeted at substances with potential for abuse and dependence. This vigilance was involved during the period of COVID-19 epidemic due to the significant changes in access to drugs and psychological disruption caused by the pandemic and lockdown. This article aims to present the different steps implemented by the French Addictovigilance network in collaboration with the French Health authorities from March to May 2020, including monitoring of potential harmful events, and scientific communication. The first events were identified through the continuity of the networking between the French addictovigilance centres and their partners: community pharmacies, general practitioners, specialized structures and emergency wards. As soon as the lockdown began, first cases of overdoses (lethal or not) were reported with opioids, mainly with methadone, and other opioids (heroin, oxycodone, tramadol or antitussive codeine). Lockdown-related noteworthy events consisted in clinical cases or other relevant information for which lockdown clearly played an important role: among the many substances identified at least once, pregabalin, benzodiazepines, cannabis, cocaine and nitrous oxide were the most significant in terms of prevalence, seriousness or particularly specific to the lockdown context. Despite significant decrease in the activity and travel limited to vital needs, community pharmacies continued to identify falsified prescriptions in this period, highlighting an increase in suspicious requests for pregabalin, codeine and tramadol. In parallel, the French addictovigilance network continued its communications efforts in the period, issuing a newsletter on tramadol, a press release on methadone and naloxone, and participating in the COVID-19 frequently asked questions (FAQs) of the French Society of Pharmacology and Therapeutic website (https://sfpt-fr.org/covid19). COVID-19 epidemic has been an important challenge for addictovigilance, and has proved that this monitoring is highly essential for alerting health professionals and health authorities to points of vigilance in the field of psychoactive substances.
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Spachos D, Siafis S, Bamidis P, Kouvelas D, Papazisis G. Combining big data search analytics and the FDA Adverse Event Reporting System database to detect a potential safety signal of mirtazapine abuse. Health Informatics J 2020; 26:2265-2279. [PMID: 32026758 DOI: 10.1177/1460458219901232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study sought to detect a potential safety signal of mirtazapine abuse by combining two different sources of surveillance, specifically Google Analytics (Google, Inc., Mountain View, CA, USA) and the FDA Adverse Event Reporting System database. Data from the first quarter of 2004 to the second quarter of 2017 were collected and analysed. The search interest over time, the frequencies of abuse-related terms in the search analytics domain, and the odds ratio of abuse events in FDA Adverse Event Reporting System were determined. Correlations between the two aforementioned domains using quarterly data from the timeline series were also assessed. Our results suggest a positive correlation between abuse-related searches in the Google domain and abuse-related events in FDA Adverse Event Reporting System database. These results indicate that these methods can be used in combination with each other as a pharmacovigilance supplementary tool to detect drug safety signals.
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Micallef J, Jouanjus É, Mallaret M, Lapeyre Mestre M. [Safety signal detection by the French Addictovigilance Network: Innovative methods of investigation, examples and usefulness for public health]. Therapie 2019; 74:579-590. [PMID: 31694770 DOI: 10.1016/j.therap.2019.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
Abstract
The French Addictovigilance Network aims to monitor all psychoactive substances with abuse potential including prescription drugs and other legal and illegal substances such as new psychoactive substances (NPS) and its consequences in humans. Created in 1990 through a network of regional addictovigilance centres covering the entire country, these pharmacologists with expertise in addictovigilance have developed interface with different partners (physicians, toxicologists, network of community pharmacies, addictology care centers…) and implemented several original tools of pharmacosurveillance (such as DRAMES [death related to the abuse of medicines] in strong collaboration with toxicologists or such OPPIDUM [observation of illegal products and misuse of psychotropic medications]), complementary to the spontaneous reporting. A such multidimensional approach including proactive surveillance by these tools and also among several heterogenous data sources (such as data from hospitals or claims database) is able to detect early addictovigilance signals and warnings as illustrated with three following examples: cannabis use and acute serious cardiovascular disorders, new synthetic opioids (ocfentanil, carfentanil) and severe opiate overdose or deaths, the diverted use of psychoactive drugs (codeine analgesics or sedative H1 antihistamines called purple drank) by adolescents and young adults. The choice of a broad strategy and the multifaceted system implemented by the French Addictovigilance Network using elements of pharmacology (fundamental, clinical, pharmacoepidemiology) expertise is an innovative method to detect early addictovigilance signals, and to describe its characteristics in order to increase awareness of psychoactive substances by patients, users and health professionals.
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Affiliation(s)
- Joëlle Micallef
- UMR 1106, Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Marseille, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, Aix-Marseille université, 13005 Marseille, France.
| | - Émilie Jouanjus
- UMR 1027 Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Toulouse, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, université Paul-Sabatier, 31000 Toulouse, France
| | - Michel Mallaret
- Centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, centre hospitalo-universitaire de Grenoble, 38043 Grenoble, France
| | - Maryse Lapeyre Mestre
- UMR 1027 Inserm, service de pharmacologie clinique, centre hospitalo-universitaire de Toulouse, centre d'évaluation et d'information sur la pharmacodépendance - addictovigilance, université Paul-Sabatier, 31000 Toulouse, France
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Jouanjus E, Micallef J, Mallaret M, Lapeyre-Mestre M. Comment on: An Insight Into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions. Int J Neuropsychopharmacol 2019; 22:528-530. [PMID: 31194866 PMCID: PMC6672683 DOI: 10.1093/ijnp/pyz033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 11/24/2022] Open
Abstract
After the publication of an article discussing the methodological options to detect the diversion potential of prescription drugs, this letter presents the multidimensional functioning of the French Addictovigilance System. This system aims at monitoring all substances with abuse potential, relying on a network of experts specialized in clinical and fundamental pharmacology. For more than 25 years, we have created collaborations with partners at the interface with field data related to substance use and the potential related disorders. When relevant depending on the context, these data sources are explored and crossed to analyze the abuse potential of one given substance. This organizational approach is useful to detect early Addictovigilance warning signals and to take appropriate measures. Generalizing such a multidimensional approach outside France appears an appealing option to move towards more effective Addictovigilance systems at the international level.
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Affiliation(s)
- Emilie Jouanjus
- CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Toulouse, France
- French Addictovigilance Network
| | - Joëlle Micallef
- CEIP-Addictovigilance, Service de Pharmacologie Clinique, CHU Timone, Marseille, France
- French Addictovigilance Network
| | - Michel Mallaret
- CEIP-Addictovigilance, Service de Pharmacologie Clinique, CHU Grenoble, Grenoble, France
- French Addictovigilance Network
| | - Maryse Lapeyre-Mestre
- CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Toulouse, France
- French Addictovigilance Network
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Dupui M, Micallef J, Lapeyre-Mestre M. Interest of large electronic health care databases in addictovigilance: Lessons from 15 years of pharmacoepidemiological contribution. Therapie 2019; 74:307-314. [DOI: 10.1016/j.therap.2018.09.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/29/2018] [Indexed: 10/27/2022]
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Lapeyre-Mestre M. Identification and tracking of addictovigilance signals in general practice: which interactions between the general practitioners and the French addictovigilance network? Fundam Clin Pharmacol 2018; 32:641-642. [DOI: 10.1111/fcp.12425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Maryse Lapeyre-Mestre
- CEIP-Addictovigilance; CIC 1436 CIC de Toulouse; Service de Pharmacologie Médicale et Clinique; CHU de Toulouse; UMR-INSERM 1027; 37 Allées Jules Guesde 31000 Toulouse France
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11
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The Misuse and Abuse of Ophthalmic Preparations: a Scoping Review of Clinical Case Presentations and Extant Literature. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-017-9868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ponté C, Pi C, Palmaro A, Jouanjus E, Lapeyre‐Mestre M. Early signal of diverted use of tropicamide eye drops in France. Br J Clin Pharmacol 2017; 83:1791-1800. [PMID: 28239898 PMCID: PMC5510080 DOI: 10.1111/bcp.13272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/31/2017] [Accepted: 02/18/2017] [Indexed: 01/16/2023] Open
Abstract
AIMS Tropicamide is a mydriatic drug used as eye-drops for diagnostic or therapeutic purposes. From 2013, a diverted use by intravenous route has been suspected in Eastern Europe in opioids users. To date, no signal of misuse has been identified in France. The aims of this study were to investigate any early signals of a diverted use of tropicamide eye drops and to collect information regarding motives for the misuse and tropicamide-induced effects. METHODS Information was obtained at three levels: (1) at regional level (Midi-Pyrénées area), from reimbursement data and pharmacists' reports on suspicious requests; (2) at national level: from reimbursement data and prescriptions suggesting possible abuse from the OSIAP (Ordonnances Suspectes, Indicateur d'Abus Possible) survey; and (3) at international level: from VigiBase® reports and Web sources. Beta-blocker eye-drops were used as comparators. RESULTS In France, in 2014-2015, 17 (0.91%, 95% CI [0.53-1.46%]) falsified prescriptions involving tropicamide were identified in the OSIAP survey (compared with 0%, 95% CI [0-0.19%] for beta-blockers). Moreover, 37 other suspicious prescriptions were presented in 2015 (notified in 2016). In Midi-Pyrénées, seven patients aged 35-49 were reimbursed for 19-45 vials of 10 ml, in a year. Since September 2014, the regional Addictovigilance Centre has received 91 notifications of suspicious requests to obtain tropicamide. In VigiBase® , two cases were identified but none in France. An increased interest in tropicamide-related Internet searches was observed from Russia and Ukraine. CONCLUSIONS These results represent the first early warnings of a tropicamide diverted use in France. Tropicamide abusers would seek euphoria or hallucinations. The high doses involved in intravenous administration could lead to serious complications.
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Affiliation(s)
- Camille Ponté
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
| | - Christian Pi
- Direction de la Santé Publique, Pôle Alertes, Risques et VigilancesARS Languedoc‐Roussillon‐Midi‐Pyrénées26–28 Parc club du Millénaire, 1 025, rue Henri BecquerelCS30001, 34067Montpellier Cedex 2France
| | - Aurore Palmaro
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
- Service de Pharmacologie Médicale et CliniqueCHU ToulouseToulouseFrance
| | - Emilie Jouanjus
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
| | - Maryse Lapeyre‐Mestre
- CEIP‐Addictovigilance, Service de Pharmacologie Médicale et CliniqueUMR1027 Inserm‐Université Paul Sabatier Toulouse III37 allées Jules Guesde31000ToulouseFrance
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