Identification des complications graves associées à l'usage de substances psychoactives

Le système d'addictovigilance français recueille les cas d'abus et de pharmacodépendance graves aux substances psychoactives mais est limité du fait d'une sous-notification. Dans cette thèse, nous avons estimé la fréquence des complications associées à ces substances dans la zone géographique couverte par le Centre Hospitalier Universitaire (CHU) de Toulouse. D'une part, en appliquant la méthode de capture-recapture à trois sources de données, notamment la base de données hospitalière (PMSI, Programme de Médicalisation des Systèmes d'Information). D'autre part, à partir des hospitalisations en lien avec la prise de cannabis enregistrées dans le PMSI. Ces derniers travaux ont mis en évidence un nombre relativement élevé de complications cardiovasculaires, que nous avons ensuite spécifiquement caractérisées en utilisant les données du système d'addictovigilance français (Notifications spontanées) dans le cadre d'une étude nationale. Au total, ce travail de thèse a permis de caractériser qualitativement et quantitativement les complications associées à l'usage de substances psychoactives, en particulier le cannabis, et d'évaluer la pertinence de l'utilisation de différentes sources de données pour l'identification de ces complicationsThe French Addictovigilance system is unique in Europe. However, it is not meant to reliably and exhaustively comprehend the dangerousness of drugs with potential of abuse. Notably, the under-reporting of serious abuse and dependence cases raises the issue of the relevance of using these data to assess the medical complication risk associated with psychoactive drug use. Another possible approach could be the use of administrative computerized hospital databases. We used data from the French hospital database PMSI (Programme de Médicalisation des Systèmes d'Information) to estimated the frequency of complications related to psychoactive substance use. First, three-source-capture-recapture analysis was applied. Then, cannabis-related hospitalizations identified from PMSI were systematically reviewed. These studies revealed a relatively high prevalence of cardiovascular complications, and these findings led us to specifically characterize cannabis-related cardiovascular complications at the national level by using the data collected by the French Addictovigilance System (i.e. Spontaneous Reports). To conclude, this thesis enabled to qualitatively and quantitatively characterize psychoactive-drug-related-complications, particularly cannabis. Doing so, we assessed the relevance of the data sources which can possibly be explored to identify serious complications related to psychoactive drug use (including PMSI), and defined methodological criteria in order to make the best use of the

Manifestations cliniques médicales associées à l'usage de cannabis (approche pharmacoépidémiologique)

Le cannabis est la substance psychoactive illicite la plus consommée en France. Or le risque sanitaire lié au cannabis n'est pas clairement élucidé et le système français de recueil des cas d'abus et de dépendance ne permet pas d'appréhender de façon fiable et exhaustive sa dangerosité. L'objectif de ce travail était d'estimer la fréquence des effets indésirables graves liés à la consommation de cannabis. Nous avons estimé cette fréquence à partir des données du Programme de Médicalisation des Systèmes d'Information (PMSI) relatives aux hospitalisations survenues au CHU de Toulouse entre janvier 2004 et juin 2007. En 2006, ce risque était de 1,6 (IC95% = [1,1 2,1]). Il s'agissait majoritairement de troubles psychiatriques (18,7%), de troubles du système nerveux central et périphérique (15,8%), de troubles cardiovasculaires (9,4%) et de troubles respiratoires (8,9%). Cette méthode devrait contribuer à améliorer la prise en charge médicale des patients abuseurs de cannabis.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Memantine misuse and diversion practices: a netnographic analysis of users' experiences published online

International audienceIntroduction: Memantine, an NMDA receptor antagonist indicated in the treatment of Alzheimer’s disease, presents pharmacodynamics similarities with commonly misused and diverted drugs including ketamine and dextromethorphan. However, there is, to our knowledge, no description of such practices with memantine. The objective was to characterize the consumption practices of memantine by implementing a netnographic study.Methods: We performed a netnographic study by applying ethnographic methods to publicly available online content of web forums. We identified the memantine users’ experiences posted on English and French-written web forums. We anonymously extracted all related discussion threads, posted anytime until July 2019, except those reporting experiences in Alzheimer’s disease. A qualitative thematic content analysis was performed.Results: We included 128 discussion threads from 5 websites: reddit.com (n=104); drugs-forum.com (n=9); erowid.org (n=8); bluelight.org (n=5) and psychoactif.org (n=2). We classified the related content in six themes: i) Products, sourcing and decision making (n=31); ii) Motivation for use (n=95); iii) Route of administration and doses (n=70); iv) Perceived effects and outcomes (n=109); v) Comparison or combination to other drugs (n=30); vi) Tolerance and abuse potential (n=23). When details were available, users were mostly males, aged between 18 and 27 and experimented recreational drug users. They reported using memantine for therapeutic purposes or in search for recreational, dissociative effects; and described a limited abuse/addiction liability due to pharmacological features perceived as detrimental for misuse and to the easy access of more attractive substances.Discussion: Our analysis highlighted two types of uses, either motivated by recreational or therapeutic purposes and characterized by broadly different practices. Although of lower magnitude than those observed with other dissociative drugs, memantine misuse and diversion practices exist and are shared online by users. The use of an innovative online ethnographic method is useful to describe previously unknown drug consumption practices from the users’ perspective

Comment on: An Insight Into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions

International audienceAbstract After the publication of an article discussing the methodological options to detect the diversion potential of prescription drugs, this letter presents the multidimensional functioning of the French Addictovigilance System. This system aims at monitoring all substances with abuse potential, relying on a network of experts specialized in clinical and fundamental pharmacology. For more than 25 years, we have created collaborations with partners at the interface with field data related to substance use and the potential related disorders. When relevant depending on the context, these data sources are explored and crossed to analyze the abuse potential of one given substance. This organizational approach is useful to detect early Addictovigilance warning signals and to take appropriate measures. Generalizing such a multidimensional approach outside France appears an appealing option to move towards more effective Addictovigilance systems at the international level

Patterns of gabapentin and pregabalin use and misuse: Results of a population‐based cohort study in France

International audienceAims The aim of this study was to assess the use and factors associated with the misuse of gabapentin and pregabalin in the general French population, through a cohort study in the EGB (General Sample of Beneficiaries), a national representative sample of the French general population. Methods New users of gabapentin and pregabalin were identified from June 2006 to December 2014, and new users of duloxetine served as control group. Misuse was defined as a use of higher daily doses than recommended. Cox proportional hazard regression models were performed to identify associated factors of misuse. Results Misuse was more frequent in the 8692 new users of pregabalin (12.8%) than in the 1963 gabapentin (6.6%) or the 3214 duloxetine new users (9.7%) ( P  70 years 1.98 [1.70–2.31] and HR [58–70] versus > 70 years 1.25 [1.06–1.47]), multiple prescribers (HR 2 or 3 versus 1 prescriber 1.29 [1.15–1.45]; HR 4 or more versus 1 prescriber 1.54 [1.30–1.83]), cancer (1.28 [1.11–1.47]), multiple sclerosis (1.53 [1.07–2.18]), neuropathy (1.85 [1.19–2.89]), depression (1.26 [1.07–1.49]) and methadone (2.61 [1.16–5.84]). After this first episode of drug misuse, 11.6% of gabapentin and 10.7% of pregabalin misusers developed a primary addiction. Conclusion In a cohort of new users, misuse is more likely to occur in new users of pregabalin, with different associated factors of misuse compared to gabapentin and duloxetine. Health professionals and prescribers must be aware of this misuse potential, which could lead to abuse and dependence