Usages problématiques des médicaments à prescription médicale facultative

Alors que le marché des médicaments à Prescription médicale facultative (PMF) est en pleine expansion, il n'existe que très peu de données sur les usages problématiques de ces médicaments obtenus sans ordonnance à l'officine. L'auteur de cette thèse a participé à une étude pharmacoépidémiologique sur le mésusage, l'usage détourné, l'abus et la dépendance aux médicaments d'automédication ayant des propriétés psychoactives. Les résultats présentés dans ce mémoire mettent en évidence différents types d'usages problématiques des médicaments à PMF renfermant de la codéine (uniquement dans les spécialités antalgiques) ou un antihistaminique H1 sédatif. Le paracétamol a servi de groupe témoin. Concernant la codéine, la proportion élevée de dépendants observée dans cette étude (18%) semble liée, le plus souvent, à la persistance de la douleur. Le type de douleur le plus souvent décrit par les patients prenant la codéine quotidiennement, est la douleur des céphalées. Il est probable qu'une part non négligeable d'entre eux présente des céphalées quotidiennes chroniques dues à un usage quotidien de codéine, associée au paracétamol. L'ensemble des résultats obtenus souligne le rôle essentiel du pharmacien d'officine dans le conseil à apporter lors de la demande spontanée de médicaments à PMF à risque d'abus et de dépendance.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Misuse and Dependence on Non-Prescription Codeine Analgesics or Sedative H1 Antihistamines by Adults: A Cross-Sectional Investigation in France

<div><p>Background</p><p>Given the growing worldwide market of non-prescription drugs, monitoring their misuse in the context of self-medication represents a particular challenge in Public Health. The aim of this study was to investigate the prevalence of misuse, abuse, and dependence on non-prescription psychoactive drugs.</p><p>Method</p><p>During one month, in randomly solicited community pharmacies, an anonymous questionnaire was offered to adults requesting paracetamol (control group), codeine combined with paracetamol in analgesics, or sedative H1 antihistamines. Responses about misuse (drug use not in agreement with the Patient Information Leaflet) abuse (excessive drug use having detrimental consequences), and dependence (established according to questions adapted from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria) on psychoactive drugs were compared to those of the paracetamol control group.</p><p>Results</p><p>295 patients (mean age 48.5 years, 68.5% of women) having used one of the studied drugs during the previous month were included. Misuse and dependence to codeine analgesics concerned 6.8% and 17.8% of the patients exposed to these drugs, respectively, (n = 118), which was significantly higher than for paracetamol. 19.5% had used codeine analgesics daily for more than six months. Headache was the most frequent reason for persistent daily use. A high prevalence of persistent daily users of sedative H1 antihistamines was also observed. Whereas these drugs are recommended only for short treatment courses of occasional insomnia, 72.2% of the participants having taken doxylamine (n = 36) were daily users, predominantly for more than six months.</p><p>Conclusions</p><p>Results on misuse and dependence on non-prescription codeine analgesics suggest that chronic pain, in particular chronic cephalalgia, requires better medical care. In addition, as for hypnotics on prescription, persistent use of doxylamine for self-medication is not justified until an acceptable benefit-risk ratio for chronic sleep disturbance is shown by clinical data.</p></div

Positive responses to DSM-IV substance dependence items.

<p>Results are expressed as percentage of the patients having used non-prescription analgesic drugs containing codeine during the previous month.</p

Problematic uses of codeine (combined with paracetamol), H1 antihistamines, and paracetamol (control) among the patients having used these drugs during the previous month.

**<p>p<0.01;</p>***<p>p<0.001 (comparison to the control group).</p

Characteristics of the patients responding to the questionnaire and of users of the studied substances in the previous month.

*<p>p<0.05;</p>**<p>p<0.01;</p>***<p>p<0.001 (comparison to the control group).</p

Cases of misuse of doxylamine (daily use for more than 5 consecutive days) purchased without prescription at the community pharmacy.

<p>Cases of misuse of doxylamine (daily use for more than 5 consecutive days) purchased without prescription at the community pharmacy.</p