Evidence of clonazepam abuse liability: results of the tools developed by the French Centers for Evaluation and Information on Pharmacodependence (CEIP) network

Abstract

Recent observations suggest the existence of clonazepam abuse. To determine its importance in France, a quantitative and systematic synthesis of all clonazepam data of several epidemiological tools of the Centers for Evaluation and Information on Pharmacodependence (CEIP) network has been performed in comparison with data on others benzodiazepines (BZD). Data on clonazepam and other BZD have been analysed from different epidemiological tools: OSIAP survey that identifies drugs obtained by means of falsified prescriptions, Observation of Illegal Drugs and Misuse of Psychotropic Medications (OPPIDUM) survey that describes modalities of use and data from regional French health reimbursement system. In OSIAP survey, the proportion of clonazepam falsified prescriptions among all BZD falsified prescriptions increased. During the 2006 OPPIDUM survey, the analysis of the BZD modalities of use highlights clonazepam abuse liability (for example 23% of illegal acquisition), in second rank after flunitrazepam. Studies based on data from the French health reimbursed system show that 1.5% of subjects with clonazepam dispensing had a deviant behaviour. Among BZD, clonazepam has the second most important doctor-shopping indicator (3%) after flunitrazepam. All these data provide some arguments in favour of clonazepam abuse liability in real life and the necessity to reinforce its monitoring.

Slow-Release Oral Morphine Sulfate Abuse: Results of the Postmarketing Surveillance Systems for Psychoactive Prescription Drug Abuse in France

“…These data combined with epidemiological tools (OPPIDUM, OSIAP) devoted to assessment of drug abuse allowed the collection of representative data of morphine sulfate abuse in France. The results of this analysis highlight the importance of sharing these pharmacoepidemiological approaches, to confirm a signal, and to specify the importance and describe their characteristics as it has been done for other products such as clonazepam or zolpidem [17,39]. …”

“…The main benzodiazepines reported were clonazepam and flunitrazepam. Flunitrazepam is one of the most abused benzodiazepines in France, and the same epidemiological tools (NotS, OPPIDUM, and OSIAP) provided some arguments in favor of clonazepam abuse [17]. The combination of benzodiazepines and opioids seems to produce greater opioid-like effects than opioids alone, which gives an indication of why these substances are used concomitantly [18].…”

A European Community Pharmacy-Based Survey to Investigate Patterns of Prescription Fraud through Identification of Falsified Prescriptions

“…The 6 countries are not representative of the entire European population, and these data cannot reliably portray the current prevalence of prescription diversion. Identification of drugs present in prescription fraud does not necessarily mean the potential for abuse without additional data [14,15]. For example, in France, most of the drugs identified in the period 2006-2007 were under alert watchfulness by the French agency for the safety of medicinal and health products 5 years later [54].…”

“…The principle of data collection of falsified prescriptions in the community pharmacy setting has been previously tested in Sweden [8,9] and France [10,11,12]. The results of these experiences suggest that these surveys can be used to advantage in drug abuse monitoring systems as additional ways of identifying signs of abuse [9,13,14,15]. A collaborative project, named OSIAP Europe (in French: ‘Ordonnances Suspectes Indicateur d'Abus Possible', Falsified Prescription Forms as an Indicator of Abuse Potential) and carried out in 6 European countries (Belgium, Italy, France, the Netherlands, Spain and Sweden), was supported by a grant from the European Commission's 2003-2008 Public Health Programme.…”

Drug Abuse Monitoring: Which Pharmacoepidemiological Resources at the European Level?

“…Indeed, France and Germany were responsible for the greatest number of relevant references, respectively 15 and 9. The French data came mostly from the national addictovigilance system, [16][17][18] using specific databases (observation of illicit psychotropic drugs or misuse from their drug use [observation des produits psychotropes illicites ou détournés de leur usage médicamenteux, OPPIDUM] survey; [19,20] insurance databases, [21,22] studies combining different data sources, [10,23] studies on the French pharmacovigilance database). For Germany, studies were mostly done in the PharmaceuticalsMonitoring (Monitoring des Arzneimittelmisbrauchs bei Klienten Ambulanter Suchtberatungstellen [PHAR-MON]) database, a national registration system collecting data on drug use by outpatients seen in addiction specialized centres, [24] or were studies performed in a single centre, on psychiatric populations, in emergency rooms or on toxicological data.…”