Article de Périodique
People who inject oral morphine favor experimentation with injectable opioid substitution (2023)
Auteur(s) :
C. BERTIN ;
P. DECLE ;
P. CHAPPARD ;
P. ROUX ;
N. AUTHIER
Article en page(s) :
art. 130
Refs biblio. :
39
Domaine :
Autres substances / Other substances
Langue(s) :
Anglais
Discipline :
EPI (Epidémiologie / Epidemiology)
Thésaurus géographique
FRANCE
Thésaurus mots-clés
ADDICTOVIGILANCE
;
MORPHINE
;
INJECTION
;
OPIOIDES
;
TRAITEMENT DE MAINTENANCE
;
SURDOSE
;
MESUSAGE
;
ETUDE TRANSVERSALE
;
ATTENTE
;
PRESCRIPTION MEDICALE
;
PREVALENCE
Résumé :
BACKGROUND: The French Addictovigilance network has observed the existence of the intravenous use of oral morphine capsules among people suffering from opioid use disorders. According to persons who inject morphine, these capsules are easy to dissolve and then inject, giving them the image of an "injectable" opioid substitution treatment (OST). In France, validated OSTs are only available orally, so dissolving morphine capsules represents the only alternative for patients who are not sufficiently relieved by oral forms. This practice presents risks related to the potential persistence of particles of the oral galenic in the injectable solution, despite its filtration, but also risks-notably of overdose-related to the pharmacological effects of opioids and to variations of the quantities of morphine extracted during the dissolution of the capsules. We conducted an online survey among the people concerned to collect data on their needs and expectations regarding a possible injectable substitution.
METHOD: An anonymous online survey including all voluntary respondents residing in France and using oral morphine intravenously was conducted in partnership with the Psychoactif harm reduction organization, from 23/03/2020 to 01/04/2021.
RESULTS: The analysis of the 157 exploitable questionnaires showed that 41% of the respondents obtained their drugs only from illegal markets. The others received, regularly or occasionally, medical prescriptions, reimbursed in 84% of cases. For 78% of the respondents, injection was the most frequent route of morphine administration, with 3.8±2 injections per day. 56% of the respondents were receiving an OST, on prescription (79%), monthly (86%), in addition to morphine. Skenan® capsules were the most frequently used (81%) and 47.2% of the respondents had already experienced injection-related complications. 95% of the respondents were in favor of experimenting with an injectable morphine substitution. Those who never received medical prescriptions were the youngest (<25 years) respondents, they reported only occasional use of morphine, and always intravenously.
CONCLUSION: Oral morphine capsules dissolved and injected intravenously are not a safe and sustainable injectable substitution. Respondents wish to be able to benefit from an injectable substitution with a formulation adapted to the intravenous route. The availability of an injectable substitution would facilitate harm reduction and entry into care for the people concerned, particularly the youngest who have never received morphine prescriptions.
METHOD: An anonymous online survey including all voluntary respondents residing in France and using oral morphine intravenously was conducted in partnership with the Psychoactif harm reduction organization, from 23/03/2020 to 01/04/2021.
RESULTS: The analysis of the 157 exploitable questionnaires showed that 41% of the respondents obtained their drugs only from illegal markets. The others received, regularly or occasionally, medical prescriptions, reimbursed in 84% of cases. For 78% of the respondents, injection was the most frequent route of morphine administration, with 3.8±2 injections per day. 56% of the respondents were receiving an OST, on prescription (79%), monthly (86%), in addition to morphine. Skenan® capsules were the most frequently used (81%) and 47.2% of the respondents had already experienced injection-related complications. 95% of the respondents were in favor of experimenting with an injectable morphine substitution. Those who never received medical prescriptions were the youngest (<25 years) respondents, they reported only occasional use of morphine, and always intravenously.
CONCLUSION: Oral morphine capsules dissolved and injected intravenously are not a safe and sustainable injectable substitution. Respondents wish to be able to benefit from an injectable substitution with a formulation adapted to the intravenous route. The availability of an injectable substitution would facilitate harm reduction and entry into care for the people concerned, particularly the youngest who have never received morphine prescriptions.
Affiliation :
CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, CHU Gabriel Montpied, Clermont Ferrand, France
Observatoire Français des Médicaments Antalgiques (OFMA), French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
Association PsychoACTIF, Marseille, France
CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, CHU Gabriel Montpied, Clermont Ferrand, France
Observatoire Français des Médicaments Antalgiques (OFMA), French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
Association PsychoACTIF, Marseille, France
CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, CHU Gabriel Montpied, Clermont Ferrand, France