Le mésusage du fentanyl en France : 2010 à 2015

Tournebize, Juliana; Gibaja, Valérie; Frauger, Élisabeth; Authier, Nicolas; Seyer, Dominique; Perri-Plandé, Joëlle; Fresse, A.S.; Gillet, Pierre; Javot, Lucie; Kahn, Jean‐Pierre; d’Addictovigilance, et le Réseau Français

doi:10.1016/j.therap.2019.11.002

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…18 Safety monitoring of transmucosal fentanyl in France has highlighted a high percentage of inappropriate use with insufficient use of background opioid treatment in 72% of cases. 19 Overlapping prescriptions was observed in a small part of patients (2-3%). It suggests a potential behaviour of doctor shopping independently of prescribing practices.…”

Section: Discussionmentioning

confidence: 97%

“…This cop- We cannot exclude that some patients may have falsified prescription forms in order to obtain transmucosal fentanyl, but information from other French studies on falsified prescription does not support this hypothesis. 19,51 Third, because of the nature of the data, this study could not take into account the intentionality of potential misuse, nor aberrant opioid adherence, which may represent a warning criterion for the prescriber. We did not have access to other clinical information explaining why some contraindicated prescriptions were done, but these situations were rare (<2% of PIU).…”

Section: Discussionmentioning

confidence: 99%

“…3,17 Treatment of breakthrough cancer pain with transmucosal fentanyl is mainly for patients in the year of their death, 18 but some of them are not treated in accordance with an opioid background treatment. 19,20 The aim of this retrospective population-based study was to investigate potentially inappropriate use of strong opioid analgesics in French cancer outpatients during their last year of life and to identify potential associated factors.…”

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confidence: 99%

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Potential inappropriate use of strong opioid analgesics in cancer outpatients during the last year of life in France and associated factors

Chu

Rueter

Palmaro

et al. 2021

Brit J Clinical Pharma

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A better knowledge of opioid prescribing patterns would help to identify areas of potential improvement in cancer pain management. This study aimed to identify potential inappropriate use (PIU) of strong opioid analgesics in cancer outpatients in their last year of life. Methods: A retrospective cohort of cancer patients who died between 2011 and 2014 and were exposed as outpatient to a strong opioid analgesic in the last year of life was identified in the Echantillon Généraliste de Bénéficiaires (a 1/97th random sample of the French general population). Prescribing patterns of strong opioids were analysed and PIU was defined by at least 1 of these criteria: overlapping prescriptions; contraindicated prescriptions; lack of laxatives; potential drug interactions; prescription in patients hospitalized for opioid-related disorders. Factors associated with PIU were investigated through a multiple logistic regression model. Results: One third of the 2236 patients (median age 72 years [interquartile range: 61-82], 44.1% women) presented a PIU (insufficient laxative prescription [19.6% of patients], insufficient background treatment with transmucosal fentanyl [14.8%],overlapping prescriptions [2.6%]). The rate of PIU significantly decreased from 37.6% (2011) to 29.8% (2014). For patients with a duration of opioid use ≥3 months, factors associated with PIU were fentanyl prescription (adjusted odds ratio = 2.36; 95% confidence interval [1.86-3.00]) and previous use of strong opioid (adjusted odds ratio = 1.88; [1.50-2.36]). Conclusion:In France, 1/3 of cancer patients exposed to strong opioids experienced PIU and this proportion tended to decrease over time. There is still room for progress in cancer pain management at the end of life.cancer, end of life, misuse, opioid analgesics, potentially inappropriate prescription | INTRODUCTIONDue to clinical and therapeutic progress, cancer has become a chronic disease most often associated with chronic cancer-related pain of varying intensity, affecting the patients' daily activities and quality of life. Several recommendations assist health professionals in the management of cancer pain with optimal efficiency and no major adverse effects. 1 However, effective cancer pain management in

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Potential inappropriate use of strong opioid analgesics in cancer outpatients during the last year of life in France and associated factors

Chu

Rueter

Palmaro

et al. 2021

Brit J Clinical Pharma

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“… 23 However, no significant increase in fentanyl- or oxycodone-related deaths was observed in France during 2011 to 2021. Neither the frequent off-label use (oral transmucosal fentanyl formulations prescribed for noncancer pain) and the risk of primary fentanyl dependence 24 nor the large increase in the number of individuals with “doctor-shopping” behavior for oxycodone (a proxy for potential misuse or abuse) 25 resulted in a significant increase in mortality. In light of the US crisis, the French harm-reduction model, the legal framework for access to strong opioids, and the multimodal approach to pain treatment may prove inspiring.…”

Section: Discussionmentioning

confidence: 99%

Trends in Fatal Poisoning Among Drug Users in France From 2011 to 2021

Revol,

Willeman,

Manceau

et al. 2023

JAMA Netw Open

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ImportanceThe DRAMES (Décès en Relation avec l’Abus de Médicaments Et de Substances) register is a database of drug-related deaths with the aim of identifying the psychoactive substances associated with and estimating the trends in these deaths. Our novel approach is based on the collection of data on all deaths for which toxicology experts have performed analyses.ObjectiveTo describe drug-related deaths in France and report trends over an 11-year period.Design, Setting, and ParticipantsThis case series used a national register to assess 4460 drug-related deaths that occurred from 2011 to 2021 in France. Data analyses were performed from January 1, 2012, to December 31, 2022.Main Outcomes and MeasuresDemographic characteristics; medical and substance abuse history; forensic autopsy findings; and toxicology reports.ResultsAmong the 4460 deceased individuals (mean [SD] age, 37.8 [10.5] years), the mortality rate was highest among men (sex ratio, 4.4:1). Of the deaths involving a single or predominant drug, the legal substitution product, methadone, was the leading cause of death during the entire study period, ahead of heroin—44.7% and 35.9% for methadone vs 15.8% and 21.8% for heroin in 2011 and 2021, respectively. Between 2011 and 2021, most of the drug-related deaths shifted from licit to illicit drugs, and statistically significant variations were found for buprenorphine, cocaine, heroin, methadone, and other licit opioids. Deaths related to polydrug use increased from 23.2% in 2011 to 30.6% in 2021. In this context, opioids remained associated with most deaths, with at least 1 opioid being involved in approximately 9 of 10 cases (85.9%) in 2021. However, the main trend was the dramatic increase in drug combinations with cocaine, from less than one-third of cases in 2011 (30.8%) to more than half in 2021 (57.8%).Conclusions and RelevanceThis case series assessment of 4460 drug-related deaths found that opioids used alone or in combination were the main contributor to drug-related deaths, despite having a lower prevalence than other drugs. This finding is similar to that of other countries; however, in France licit methadone was the leading cause of opioid-related deaths (ahead of heroin) during the study period. Deaths associated with use of cannabis, new psychoactive substances, and stimulants (including amphetamine-type stimulants and cocaine, especially in combination) have increased and should be closely monitored.

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“…Detecting and identifying signals are a cornerstone for addictovigilance actors: they need to be able to label a piece of information received as a signal [5,10,20,25,[31][32][33]. Signals suggesting a public health risk are collected and analysed in continuous manner in a surveillance process implemented by watchdog or public health structures, in a perspective of alert, anticipation and early action.…”

Section: Periodical Assessment Of Covid Noteworthy Events (Simad-covid)mentioning

confidence: 99%