Titre : | Systematic assessment of non-medical use of prescription drugs using doctor-shopping indicators: A nation-wide, repeated cross-sectional study (2023) |
Auteurs : | T. SOEIRO ; V. PRADEL ; M. LAPEYRE-MESTRE ; J. MICALLEF |
Type de document : | Article : Périodique |
Dans : | Addiction (Vol.118, n°10, October 2023) |
Article en page(s) : | 1984-1993 |
Langues: | Anglais |
Discipline : | EPI (Epidémiologie / Epidemiology) |
Mots-clés : |
Thésaurus géographique FRANCEThésaurus mots-clés ETUDE TRANSVERSALE ; MEDICAMENTS ; MESUSAGE ; PRESCRIPTION MEDICALE ; CONSULTATION ; OPIOIDES ; BENZODIAZEPINES ; ADDICTOVIGILANCE ; EPIDEMIOLOGIE ; PREGABALINE ; INDICATEUR ; BASE DE DONNEES ; EVOLUTION |
Résumé : |
AIMS: The aim of this study was to present the first nation-wide, systematic, repeated assessment of doctor-shopping (i.e. visiting multiple physicians to be prescribed the same drug) during 10 years for more than 200 psychoactive prescription drugs in the 67 million inhabitants in France.
DESIGN: This was a nation-wide, repeated cross-sectional study. SETTING AND PARTICIPANTS: Data are from the French National Health Data System in 2010, 2015 and 2019 for 214 psychoactive prescription drugs (i.e. anaesthetics, analgesics, antiepileptics, anti-Parkinson drugs, psycholeptics, psychoanaleptics, other nervous system drugs and antihistamines for systemic use). MEASUREMENTS: The detection and quantification of doctor-shopping relied upon an algorithm that detects overlapping prescriptions from repeated visits to different physicians. We used two doctor-shopping indicators aggregated at population level for each drug dispensed to more than 5000 patients: (i) the quantity doctor-shopped, expressed in defined daily doses (DDD), which measures the total quantity doctor-shopped by the study population for a given drug; and (ii) the proportion doctor-shopped, expressed as a percentage, which standardizes the quantity doctor-shopped according to the use level of the drug. FINDINGS: The analyses included approximately 200 million dispensings to approximately 30 million patients each year. Opioids (e.g. buprenorphine, methadone, morphine, oxycodone and fentanyl), benzodiazepines and non-benzodiazepine hypnotics (Z-drugs) (e.g. diazepam, oxazepam, zolpidem and clonazepam) had the highest proportions doctor-shopped during the study period. In most cases, the proportion and the quantity doctor-shopped increased for opioids and decreased for benzodiazepines and Z-drugs. Pregabalin had the sharpest increase in the proportion doctor-shopped (from 0.28 to 1.40%), in parallel with a sharp increase in the quantity doctor-shopped (+843%, from 0.7 to 6.6 DDD/100 000 inhabitants/day). Oxycodone had the sharpest increase in the quantity doctor-shopped (+1000%, from 0.1 to 1.1 DDD/100 000 inhabitants/day), in parallel with a sharp increase in the proportion doctor-shopped (from 0.71 to 1.41%). Detailed results for all drugs during the study period can be explored interactively at: https://soeiro.gitlab.io/megadose/. CONCLUSIONS: In France, doctor-shopping occurs for many drugs from many pharmacological classes, and mainly involves opioid maintenance drugs, some opioids analgesics, some benzodiazepines and Z-drugs and pregabalin. |
Domaine : | Autres substances / Other substances |
Refs biblio. : | 42 |
Affiliation : |
Aix-Marseille Université, Inserm, Marseille, France Unité de pharmacoépidémiologie, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Hôpitaux universitaires de Marseille, Marseille, France Université de Toulouse, Inserm, Toulouse, France Centre d'évaluation et d'information sur la pharmacodépendance-Addictovigilance, Service de pharmacologie clinique, Centre hospitalier universitaire de Toulouse, Toulouse, France |
Cote : | Abonnement |
Lien : | https://doi.org/10.1111/add.16261 |
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