Trends in opiate and opioid poisonings in addicts in north-east Paris and suburbs, 1995-99

FRANÇAIS :
Etude rétrospective sur 5 ans des données d'une unité de soins intensifs (80 patients), du SAMU93 (421 patients) et des services de police parisien (40 patients décédés) dont les résultats montrent : une stabilité ou une diminution du nombre d'intoxications et de la mortalité liée ; une polyconsommation opiacés, opioïdes aussi courante qu'une polyconsommation avec d'autres substances psychoactives ; et, un lien entre la diminution de la mortalité et l'introduction de la buprénorphine haut-dosage dans le soin aux toxicomanes en France.
ENGLISH :
Aims: (1) To assess the trends in the number, mortality and the nature of severe opiate/opioid poisonings from 1995 to 1999 in north-east Paris and adjacent suburbs and (2) to examine the effects of' the introduction of high-dose buprenorphine on these parameters. Design: Retrospective, 5-year study with review of pre-hospital, hospital and post-mortem data. Setting and participants: Eighty patients from the toxicological intensive care unit (TICU) in north-east Paris, 421 patients from the pre-hospital emergency medical service in a north-east suburb of Paris (SAMU 93) and 40 deaths from the coroner's office in Paris. Measurements and results: We found that the number of pre-hospital opiate/opioid poisonings and deaths decreased over 5 years. During the same time frame, opiate/opioid poisoning admissions to our TICU remained steady, but the number of deaths declined. From 1995 to 1999, the detection of buprenorphine among opiate/opioid-poisoned TICU patients increased from two to eight occurrences per year while detection of opiates diminished from 17 to 10 occurrences per year. Increased buprenorphine detection correlated directly with increasing sales over this time period. In spite of the increased use of buprenorphine, the mortality associated with opiate/opioid poisonings has diminished in the pre-hospital environment from 9% in 1995 to 0% in 1999, and in the TICU from 12% in 1995 to 0% in 1997 and thereafter. We found a high frequency of multiple opiate/opioid use in severe poisonings, as well as the frequent association of other psychoactive drugs including ethanol. Conclusions: The number and the mortality of opiate/opioid poisonings appear to be stable or decreasing in our region. The association of multiple opiates/opioids appears nearly as common as the association with other psychoactive drugs. The introduction of high-dose buprenorphine coincides with a decrease in opiate/opioid poisoning mortality. Further study will be necessary to clarify this observation. (Author' s abstract)