Evidence of slow‐release morphine sulfate abuse and diversion: epidemiological approaches in a French administrative area

Abstract

Slow-release oral morphine sulfate (SM) is one of the most abused prescription opioids in France. However, the regional feature of the abuse of morphine is poorly documented. To investigate the abuse of SM in a French administrative region, a multisource approach was applied. The first approach was based on SM exposition at national and regional level using the OPPIDUM survey. In a second approach, we analyzed a drug reimbursement database to assess the magnitude of SM abuse in Languedoc-Roussillon (LR) region. A clustering method was applied to classify patients and to describe the profile of deviant patients. The third approach was based on a self-administered anonymous questionnaire, proposed to patients seen in addiction care centers in the LR region and consuming oral SM. The OPPIDUM study showed that in most regions, where the prevalence of heroin use is higher than the national average of 9.1%, SM consumers were fewer. With the clustering method, three subgroups were identified. One of them gathered 35 users (3.2%) with a deviant behavior characterized by significantly more dispensations, dispensing pharmacies, and prescribers. These subjects were mainly men, younger, and more consumers of benzodiazepines and opioid maintenance therapy than the others. The third study allowed specifying that SM was mainly injected (93.7%), bought in the street (80%), and used because of unavailability and the poor quality of heroin (33.9%). The three proposed approaches are complementary and help to clarify the abuse of oral SM, while assessing the motivations of this abuse.

Patterns and profiles of methylphenidate use both in children and adults

“…Indeed, in this subpopulation, a non-negligible proportion of adults resorted to the IR formulation, which has already been linked to diversion [1]. They also used flunitrazepam (24%) or morphine sulphate (22%), which are both potential drugs of abuse [54,55], and visited a larger number of different physicians, reinforcing the hypothesis of a possible diversion of MPH by 'doctor shopping', which consists of obtaining overlapping prescriptions by two or more prescribers [56]. This behaviour has, in particular, already been characterized in the PACA-Corse region (the same geographical region as investigated in our study), with an estimated increase of 6% in the overall quantities of MPH obtained by diversion through doctor shopping in 2011 [1].…”

Aspiration in lethal drug abuse—a consequence of opioid intoxication

“…In Austria, Heroin was the main cause of opioid-related deaths [2,3,28] until the use of slow-release oral morphine became commonplace as drug substitution medication, and became the most frequently abused opiate during the early 2000s [29][30][31][32]. Although originally intended to be orally consumed, substance abuse involving slow-release oral morphine involves it being injected after the morphine has been extracted by crushing and heating [33][34][35][36][37]. Moreover, polydrug abuse is a widespread problem given that most opioid addicts consume additional substances, especially other central nervous system depressants such as alcohol and/or benzodiazepines [38][39][40]-all of them increasing the risk of a potentially fatal side effect of opioids such a respiratory depression.…”

Factors associated with perceived loss of libido in people who inject opioids: Results from a community-based survey in France

“…The PrebupIV survey (Roux et al, 2017) showed that morphine sulfate was used to get high more frequently than methadone and buprenorphine. Another French survey investigating this substance reported that 77.6% of users were searching for a rewarding effect (Peyriere et al, 2016).…”