Historique
Article de Périodique
Doctor shopping of opioid analgesics relative to benzodiazepines: A pharmacoepidemiological study among 11.7 million inhabitants in the French countries (2018)
Auteur(s) :
PONTÉ, C. ;
LEPELLEY, M. ;
BOUCHERIE, Q. ;
MALLARET, M. ;
LAPEYRE-MESTRE, M. ;
PRADEL, V. ;
MICALLEF, J.
Année
2018
Page(s) :
88-94
Langue(s) :
Anglais
Domaine :
Autres substances / Other substances
Discipline :
EPI (Epidémiologie / Epidemiology)
Thésaurus géographique
FRANCE
Thésaurus mots-clés
OPIOIDES
;
BENZODIAZEPINES
;
ANALGESIQUES
;
SURVEILLANCE EPIDEMIOLOGIQUE
;
MESUSAGE
;
PRESCRIPTION MEDICALE
;
EPIDEMIOLOGIE DESCRIPTIVE
;
MORPHINE
;
FENTANYL
Résumé :
Background: The abuse of prescription opioids and its subsequent consequences is an important public concern particularly in the USA. The literature on opioid analgesic abuse is scarce.
Objective: We assess the extent and risk of opioid analgesics abuse relative to benzodiazepines (BZD) using the doctor shopping method, taken into account the pharmacological characteristics (dosage, route of administration, extended or immediate release).
Methods: We used SNIIRAM database covering 11.7 million inhabitants. All individuals with at least one reimbursement for non-injectable opioid analgesic or BZD in 2013 were included. Opioids for mild to moderate pain and for moderately severe to severe pain were studied. The Doctor Shopping Quantity (DSQ) is the quantity obtained by overlapping prescriptions from several prescribers. The Doctor Shopping Indicator (DSI) is the DSQ divided by the total dispensed quantity.
Results: The strong opioid analgesics have the highest DSI (2.79%) versus 2.06% for BZD hypnotics. Flunitrazepam ranked first according to its DSI (13.2%), followed by morphine (4%), and zolpidem (2.2%). The three-strong opioids having the highest DSI were morphine, oxycodone and fentanyl (respectively 4%, 1.7% and 1.5%). The highest DSI was observed for the highest dosages of morphine (DSI = 8.4% for 200?mg) and oxycodone (DSI = 2.8% for 80?mg). The highest DSI for fentanyl was described with nasal and transmucosal forms (4.1% and 3.3% respectively). The highest DSI for morphine was described for extended-release (4.1%).
Conclusion: There is a need to reinforce surveillance systems to track opioid misuse and to increase awareness of healthcare professionals.
Highlights:
A doctor-shopping measure including pharmaceutical characteristics is proposed.
Doctor-shopping Opioid analgesics profile were compared to benzodiazepines.
Doctor-shopping indicators of opioids were higher than benzodiazepines.
Morphine, oxycodone and fentanyl have the highest doctor-shopping indicator.
Objective: We assess the extent and risk of opioid analgesics abuse relative to benzodiazepines (BZD) using the doctor shopping method, taken into account the pharmacological characteristics (dosage, route of administration, extended or immediate release).
Methods: We used SNIIRAM database covering 11.7 million inhabitants. All individuals with at least one reimbursement for non-injectable opioid analgesic or BZD in 2013 were included. Opioids for mild to moderate pain and for moderately severe to severe pain were studied. The Doctor Shopping Quantity (DSQ) is the quantity obtained by overlapping prescriptions from several prescribers. The Doctor Shopping Indicator (DSI) is the DSQ divided by the total dispensed quantity.
Results: The strong opioid analgesics have the highest DSI (2.79%) versus 2.06% for BZD hypnotics. Flunitrazepam ranked first according to its DSI (13.2%), followed by morphine (4%), and zolpidem (2.2%). The three-strong opioids having the highest DSI were morphine, oxycodone and fentanyl (respectively 4%, 1.7% and 1.5%). The highest DSI was observed for the highest dosages of morphine (DSI = 8.4% for 200?mg) and oxycodone (DSI = 2.8% for 80?mg). The highest DSI for fentanyl was described with nasal and transmucosal forms (4.1% and 3.3% respectively). The highest DSI for morphine was described for extended-release (4.1%).
Conclusion: There is a need to reinforce surveillance systems to track opioid misuse and to increase awareness of healthcare professionals.
Highlights:
A doctor-shopping measure including pharmaceutical characteristics is proposed.
Doctor-shopping Opioid analgesics profile were compared to benzodiazepines.
Doctor-shopping indicators of opioids were higher than benzodiazepines.
Morphine, oxycodone and fentanyl have the highest doctor-shopping indicator.
Affiliation :
Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance PACA-Corse, Service de Pharmacologie clinique, Aix-Marseille Université, Institut des Neurosciences des Systèmes UMR INSERM 1106, Marseille, France