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Bertin C, Montigne E, Teixeira S, Ferrer F, Lauwerie L, Richard D, Authier N. Intravenous misuse of slow-release oral morphine capsules: how much morphine is injected? Harm Reduct J 2023; 20:59. [PMID: 37106464 PMCID: PMC10134660 DOI: 10.1186/s12954-023-00781-2] [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: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The injection of morphine from morphine sulfate capsules containing sustained-release microbeads (Skenan®) is a practice frequently described by French intravenous opioid users. They seek an injectable form of substitution for heroin. Depending on how the syringe is prepared, the morphine rates may vary. The dosage of the capsule, the temperature of the dissolving water and the type of filter used have been identified as the parameters most likely to influence the final quantity of morphine in solution before intravenous injection. The aim of our study was to determine the amounts of morphine actually injected, according to the different preparation modalities described by people who inject morphine and the harm reduction equipment made available to them. METHODS Different morphine syringes were prepared by varying the dosage of the capsule (100 or 200 mg), the temperature of the dissolving water before adding morphine, ambient (≈ 22 °C) or heat (≈ 80 °C) and four filtration devices: risk reduction Steribox® cotton, risk reduction filter "Sterifilt®", "Wheel" filter and cigarette filter. The quantification of the morphine in the syringe body was carried out by liquid phase chromatography coupled with a mass spectrometry detector. RESULTS The best extraction yields were obtained with heated water, independently of dosages (p < 0.01). Yields of 100 mg capsules varied according to the filter (p < 0.01) and the water temperature (p < 0.01), with maximum yields obtained for solutions dissolved in heated water, then filtered with the "Wheel" filter (83 mg). The yields of the 200 mg capsules varied according to the temperature of the water (p < 0.01), without difference according to the filter used (p > 0.01), and maximum yields obtained for solutions dissolved in heated water (95 mg). CONCLUSIONS No procedure for dissolving Skenan® led to the complete dissolution of the morphine it contains. Whatever the variations in preparation conditions, the extraction rates of the 200 mg morphine capsules were lower than those of 100 mg, without the risk reduction filters adversely impacting morphine extraction. Offering an injectable substitution to persons who inject morphine would make it possible to reduce the risks and damage, particularly overdoses, associated with variations in dosage due to preparation methods.
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Affiliation(s)
- Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France.
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, 63001, Clermont-Ferrand, France.
- UFR Médecine et Professions Paramédicales, Fondation Institut Analgesia, 63001, Clermont-Ferrand, France.
| | - Edouard Montigne
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Sarah Teixeira
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Florent Ferrer
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Louis Lauwerie
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Damien Richard
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, 63001, Clermont-Ferrand, France
- UFR Médecine et Professions Paramédicales, Fondation Institut Analgesia, 63001, Clermont-Ferrand, France
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Lauwerie L, Sibut R, Maillet-Vioud C, Monteiro S, Alauze F, Martinez E, Sauniere D, Legrand-Vyskoc A, Lachal J. A retrospective cohort study comparing the social, familial and clinical characteristics of adolescents admitted to a French Emergency Department in suicidal crisis before and during the COVID-19 pandemic. Psychiatry Res 2023; 321:115080. [PMID: 36746034 PMCID: PMC9884401 DOI: 10.1016/j.psychres.2023.115080] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
The social turmoil resulting from the COVID19 pandemic has come with an increase in the incidence of suicidal crises among adolescents and in particular an increase of suicidal attempts in most Western societies. Monthly prevalence of suicidal attempts in adolescents was doubled or tripled during winter 2021 in France. This study proposes to describe the youths in suicidal crisis admitted to a French hospital during the pandemic according to their sociodemographic, familial, and clinical characteristics as well as to compare them to the adolescents who were presenting the same symptoms the years preceding the pandemic. A retrospective cohort of 332 participants was divided in two groups. The adolescents admitted during the pandemic were more frequently girls, with less familial and personal history of psychiatric care, less depressive disorders, and they were more frequently referred to psychological outpatient care than to psychiatric outpatient care. These results strengthen the hypothesis that the increase in adolescents' suicidal crisis could be an expression of the social suffering more than a result of an increase in adolescents' psychiatric disorders.
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Affiliation(s)
- Louis Lauwerie
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Romain Sibut
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | | | | | - Flavie Alauze
- Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Elisa Martinez
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Didier Sauniere
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Aurore Legrand-Vyskoc
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Jonathan Lachal
- Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, F-94807, Villejuif, France.
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