Evolution de la qualité de l'air de la communauté urbaine de Lille (1994-2002) (suivi cartographique avec des lichens)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Pharmaceutical cognitive doping in students: a chimeric way to get-a-head?

International audienceFor students, the pressing demands for memorization, top-level performance, and peer competition create an environment favorable for pharmaceutical cognitive doping behavior. We aimed to describe recent practices and the benefit/risk ratio of such behavior and to discuss the issues at stake. The prevalence of pharmaceutical cognitive doping among students has been reported from 1.3% to 33% across studies, with variations depending on country and definition of pharmaceutical cognitive doping. The therapeutic classes most frequently cited as being diverted for doping purposes are psychostimulants and nootropics (methylphenidate, modafinil, piracetam), corticosteroids, sedative drugs and beta-blockers. Some illegal substances such as cannabis, amphetamines and cocaine are also consumed in order to boost mental function. Finally, over-the-counter products, such as caffeine-based tablets or energy drinks, or alcohol, are also widely used by students whose motivations involve enhanced performance, concentration, memory, and staying awake during the revision and exam period. However, the expected (often fantasized) effectiveness of these products does not correspond to the reality of a modest controversial impact on cognitive performance. There appears to be an emerging profile of the student more inclined to doping behavior. Cognitive doping thus raises the question of its regulation, opening a debate opposing, on one hand, individual freedom and supposed collective benefits and, on the other hand, health consequences, educational (in)equality, and the risk of tarnished academic success. Strengthening school and university medicine, through prevention campaigns and the identification of subjects at risk, is essential to limit the extent, risk, and damages associated with such practices

Dopage cognitif chez les étudiants : un moyen chim(ér)ique de s’en mettre plein la tête ?

For students, the pressing demands for memorization, top-level performance, and peer competition create an environment favorable for pharmaceutical cognitive doping behavior. We aimed to describe recent practices and the benefit / risk ratio of such behavior and to discuss the issues at stake. The prevalence of pharmaceutical cognitive doping among students has been reported from 1.3% to 33% across studies, with variations depending on country and definition of pharmaceutical cognitive doping. The therapeutic classes most frequently cited as being diverted for doping purposes are psychostimulants and nootropics (methylphenidate, modafinil, piracetam), corticosteroids, sedative drugs and beta-blockers. Some illegal substances such as cannabis, amphetamines and cocaine are also consumed in order to boost mental function. Finally, over-the-counter products, such as caffeine-based tablets or energy drinks, or alcohol, are also widely used by students whose motivations involve enhanced performance, concentration, memory, and staying awake during the revision and exam period. However, the expected (often fantasized) effectiveness of these products does not correspond to the reality of a modest controversial impact on cognitive performance. There appears to be an emerging profile of the student more inclined to doping behavior. Cognitive doping thus raises the question of its regulation, opening a debate opposing, on one hand, individual freedom and supposed collective benefits and, on the other hand, health consequences, educational (in)equality, and the risk of tarnished academic success. Strengthening school and university medicine, through prevention campaigns and the identification of subjects at risk, is essential to limit the extent, risk, and damages associated with such practices.Chez les étudiants, les exigences de mémorisation exhaustive, de performance accrue et la mise en compétition entre pairs peuvent encourager les conduites de dopage cognitif. Nous avons souhaité décrire les pratiques récentes et la balance bénéfice/risque de telles conduites afin d’en discuter les enjeux. La prévalence d’usage de produits à visée stimulante chez les étudiants s’étendait de 1,3 % à 33 % selon les études, en fonction du pays considéré et de la définition de dopage cognitif retenue. Les classes thérapeutiques les plus fréquemment citées comme détournées étaient les psychostimulants et nootropiques (méthylphénidate, modafinil, piracétam), les corticoïdes, les médicaments sédatifs et les bêtabloquants. Certaines substances illicites telles que le cannabis, les amphétamines et la cocaïne pouvaient également être consommées à visée stimulante. Enfin, les produits en vente libre, comme les comprimés ou boissons énergétiques à base de caféine, ou l’alcool, étaient également largement utilisés. Les motivations étaient l’augmentation des performances, de la concentration, de la mémoire et de l’éveil pendant les révisions et les examens. Cependant, l’efficacité attendue, voire fantasmée, de ces produits se heurte au principe de réalité, avec un effet réel modeste et controversé sur le fonctionnement cognitif. Un profil d’étudiant plus enclin aux conduites dopantes semblait également se dégager. Le dopage cognitif pose la question de sa régulation à travers un débat opposant, d’une part, liberté individuelle et bénéfice collectif supposé et, d’autre part, conséquences sanitaires, inégalité des chances et diminution de la part du mérite dans la réussite. Un renforcement de la médecine scolaire et universitaire, à travers des campagnes de prévention et le repérage des sujets à risque, apparaît indispensable pour limiter l’étendue et les risques et dommages liés à de telles pratiques

Attitudes of community pharmacists to off-label prescribing of baclofen in Northern France

Background Community pharmacists' liability is involved when they dispense off-label prescriptions (OLPs). However, their attitudes to off-label prescribing are little known, while in France off-label baclofen use for alcohol dependence is increasing. Objective To determine community pharmacists' attitudes to off-label prescribing of baclofen. Method A postal questionnaire was sent to 219 community pharmacies in the Nord-Pas-de-Calais region, France, previously identified as delivering at least five boxes of oral baclofen monthly. The questionnaire examined whether pharmacists delivered baclofen for alcohol dependence, how pharmacists detected off-label prescribing of baclofen, who were the most frequent prescribers (general practitioners or specialists), and pharmacists' attitudes to OLPs. Results Eighty pharmacies responded (36.5 %). Detection criteria for OLPs were supra-threshold dose (77.3 %) and "off-label" written on prescription (52.5 %). General practitioners were the most frequent prescribers of off-label baclofen. Pharmacists were more likely to refuse to fill prescriptions not marked "off-label" (6.0 %) than correctly marked prescriptions (1.5 %). 85 % of respondents considered they lacked information on off-label use. Conclusion Although community pharmacists felt they were poorly informed on off-label baclofen, the majority nevertheless delivered the drug. Since our survey, off-label baclofen prescribing has been strictly controlled in France. Pharmacists' current attitudes will need further evaluation

Therapie

OBJECTIVES: Alprazolam, a high-potency and short-acting anxiolytic benzodiazepine, is one of the most misused benzodiazepines in France. In the context of various reports on alprazolam misuse during the COVID-19 pandemic, the objective of this study was to assess alprazolam abuse potential by analyzing French addictovigilance and international data. METHODS: Data collected from 2011 to 2020 using the following epidemiological tools of the French Addictovigilance Network were analyzed: spontaneous reports (SRs), OPPIDUM (addiction care center data), OSIAP (falsified prescriptions), DRAMES (substance-related deaths), and chemical submission surveys. Moreover, the VigiBase™ database was analyzed to evaluate alprazolam abuse liability worldwide. RESULTS: During the study period, 675 SRs concerning alprazolam misuse were recorded (sex ratio: ̴1; median age: 39 years). The desired effects were intensification of the therapeutic anxiolytic effect, euphoric effect, and management of substance withdrawal. Alprazolam was the third and first benzodiazepine listed in OPPIDUM and OSIAP surveys. Analysis of the SR and OPPIDUM data showed a recent increase in the alprazolam-opioid combination. In DRAMES data, alprazolam was directly linked to 11 deaths (associated with opioids in 10/11). VigiBase™ data analysis highlighted that France was the third country with the most cases of alprazolam misuse. The disproportionality analysis showed that in France, alprazolam was associated with higher risk of misuse and dependence compared with other benzodiazepines: reporting odds ratio=1.43, (95% CI: 1.04-1.95) and=1.97 (95% CI:1.50-2.59), respectively. CONCLUSIONS: This study highlighted an increase in various signals of alprazolam abuse in France, and an increased use of the alprazolam-opioid combination that was also linked to most of the recorded alprazolam-linked deaths. These signals have been reported also in the international literature, and should be thoroughly investigated

Dispositif pharmacoépidémiologique de surveillance des substances psychoactives : intérêts du programme national OPPIDUM du Réseau français d’addictovigilance

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