Nitrous oxide: a unique official French addictovigilance national survey

IntroductionNitrous oxide has become over the last few years a public health problem in many countries. France has a dedicated health monitoring system dedicated to the surveillance of the abuse, dependence and consequences associated with the use of psychoactive substances coordinated by the French National Agency for the Safety of Medicines and Health Products.We present the French national survey of nitrous oxide.Materials and methodsWe analyzed all the cases with nitrous oxide from 2012 to 2021: number of notifications, characteristics of the subjects and consumption, consequences reported and their evolutions over time. In addition, we have made a special focus on the four main complications reported.ResultsA total of 525 cases were received with an exponential increase since 2019. We observed changes in the characteristics of the notifications with an increase in the proportion of women [42.7% in 2021 vs. 30.8% in 2020 (p = 0.02)]; an increase in the quantities consumed (use of cylinders); a negative evolution of the contexts of use with a search for self-therapeutic effects and use in violent contexts; an increasing trend of the severity of cases [78.1% in 2021 vs. 70.0% in 2020 (p = 0.07)].The main effects were substance use disorders and/or associated criteria (82.5%), neurological disorders (75.4%), psychiatric symptoms (15.4%) and cardiovascular events (8.6%). In terms of evolution, we observed a significant increase in cases with a use disorder and an increase in neurological complications. Moreover, new serious effects, notably cardiovascular events were reported.DiscussionThe combination of high availability, varied effects from euphoria to relief of discomfort in a stressful global pandemic context and the development of dependence could explain the rapid growth of consumption and the seriousness of the cases.It must now be taken into account that (i) Substance use disorders are associated with nitrous oxide consumption; (ii) clinicians must consider “nitrous oxide” in young subjects presenting different types of manifestations; and (iii) stopping consumption is imperative and is the first treatment. In this context, an addictological assessment must also be carried out

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

Abstract Aims Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories. Methods Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017–2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis. Results The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of ‘less treated’ younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of ‘more treated’ individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of ‘treatment-stable’ older individuals with longer TT durations. Conclusions The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription

Front Public Health

INTRODUCTION: Nitrous oxide has become over the last few years a public health problem in many countries. France has a dedicated health monitoring system dedicated to the surveillance of the abuse, dependence and consequences associated with the use of psychoactive substances coordinated by the French National Agency for the Safety of Medicines and Health Products.We present the French national survey of nitrous oxide. MATERIALS AND METHODS: We analyzed all the cases with nitrous oxide from 2012 to 2021: number of notifications, characteristics of the subjects and consumption, consequences reported and their evolutions over time. In addition, we have made a special focus on the four main complications reported. RESULTS: A total of 525 cases were received with an exponential increase since 2019. We observed changes in the characteristics of the notifications with an increase in the proportion of women [42.7% in 2021 vs. 30.8% in 2020 (p = 0.02)]; an increase in the quantities consumed (use of cylinders); a negative evolution of the contexts of use with a search for self-therapeutic effects and use in violent contexts; an increasing trend of the severity of cases [78.1% in 2021 vs. 70.0% in 2020 (p = 0.07)].The main effects were substance use disorders and/or associated criteria (82.5%), neurological disorders (75.4%), psychiatric symptoms (15.4%) and cardiovascular events (8.6%). In terms of evolution, we observed a significant increase in cases with a use disorder and an increase in neurological complications. Moreover, new serious effects, notably cardiovascular events were reported. DISCUSSION: The combination of high availability, varied effects from euphoria to relief of discomfort in a stressful global pandemic context and the development of dependence could explain the rapid growth of consumption and the seriousness of the cases.It must now be taken into account that (i) Substance use disorders are associated with nitrous oxide consumption; (ii) clinicians must consider "nitrous oxide" in young subjects presenting different types of manifestations; and (iii) stopping consumption is imperative and is the first treatment. In this context, an addictological assessment must also be carried out

Perception of the Regulatory Change for Zolpidem Prescription by French General Practitioners and Its Relation to Prescription Behavior

Background: To “limit the risk of abuse and misuse” and “encourage correct usage”, the French drug regulatory authority stated that—from April 2017—zolpidem prescription must be performed on a secured prescription pad. This national study aims to evaluate the perception of general practitioners (GPs) towards this new regulation and its link with prescription strategies. Methods: We conducted structured interviews of GPs. Data were collected about GPs’ perception of the measure and therapeutic strategies towards zolpidem. The primary outcome was the description of the GPs’ strategy of prescription, based on the perception towards the new regulation for zolpidem. Results: For 206 GPs, the new regulation was mainly perceived as helpful (61%) and as a difficulty (55%). Other perceptions were the awareness of the risks of zolpidem (18%), awareness of the risks of hypnotics (13%), and nothing changed (5%). Four clusters of GPs were identified. In the clusters with the perception as a difficulty (only or associated with helpful), the GPs who applied the strategy “no modification” for >50% of their patients were more frequently compared to awareness and helpful only clusters (60.8%; 42.9%; 20.4%; 26.7%) (p < 0.001). Conclusions: We highlighted an association between the perception of the new regulation of zolpidem prescription by GPs and a strategy of prescription

Factors of misuse of psychotropic treatments : from non-compliant prescriptions to inappropriate uses

De par sa fréquence et ses conséquences multiples, le mésusage des traitements psychotropes est un enjeu majeur de santé publique. Qu’il soit lié à une prescription non-conforme ou à un usage inapproprié, l’importance du mésusage peut questionner étant donné que les conditions d’emploi d’un médicament sont règlementées par leur Résumé des Caractéristiques du Produit ainsi que les Recommandations de Bonnes Pratiques (RBP) et son bon emploi par le patient doit être transmis par le prescripteur. L’objectif de ce travail de thèse était d’investiguer les facteurs associés au mésusage des psychotropes en s’intéressant aux situations liées aux prescriptions nonconformes (par les prescripteurs) et aux usages inappropriés (par les patients). Nous nous sommes intéressés à des psychotropes mésusés par excès (benzodiazépines et apparentés (BZD/Z) dont le zolpidem) et par défaut (clozapine) en combinant données cliniques et épidémiologiques. Nous avons montré (i) qu’une perception défavorable de la réglementation du zolpidem par les prescripteurs était associée à une poursuite de prescriptions non-conformes ; (ii) que les différents parcours médicamenteux précédant la clozapine et les différentes typologies de patients mésusant les BZD/Z étaient associées à la non-application des RBP ; enfin (iii) que la méconnaissance de l’indication des BZD/Z et une compliance nonoptimale à la surveillance initiale de la clozapine étaient associées à des usages inappropriés. Ces résultats rappellent l’importance de l’anticipation des situations à risques, de la transposabilité des RBP à la complexité des patients et de la formation en pharmacologie des prescripteurs pour promouvoir le bon usage.Due to its frequency and multiple consequences, the misuse of psychotropic treatments is a major public health issue. Whether it is linked to a non-compliant prescription or to inappropriate use, the importance of misuse can be questioned given that the conditions of use of a drug are regulated by their Summary of Product Characteristics as well as the Recommendations of Good Practices (RBP) and its proper use by the patient must be transmitted by the prescriber. The objective of this thesis work was to investigate the factors associated with the misuse of psychotropic drugs by focusing on situations related to noncompliant prescriptions (by prescribers) and inappropriate uses (by patients). We were interested in psychotropic drugs misused by excess (benzodiazepines and related (BZD/Z) including zolpidem) and by default (clozapine) by combining clinical and epidemiological data. We showed (i) that an unfavorable perception of zolpidem regulation by prescribers was associated with continued non-compliant prescriptions; (ii) that the different drug courses preceding clozapine and the different typologies of patients misusing BZD/Z were associated with the non-application of RBP; finally (iii) that ignorance of the indication for BZD/Z and non-optimal compliance with the initial monitoring of clozapine were associated with inappropriate uses. These results are a reminder of the importance of anticipating risky situations, of the transposability of GPRs to the complexity of patients and of training in pharmacology for prescribers to promote proper use

Facteurs du mésusage des traitements psychotropes : des prescriptions non-conformes aux usages inappropriés

Due to its frequency and multiple consequences, the misuse of psychotropic treatments is a major public health issue. Whether it is linked to a non-compliant prescription or to inappropriate use, the importance of misuse can be questioned given that the conditions of use of a drug are regulated by their Summary of Product Characteristics as well as the Recommendations of Good Practices (RBP) and its proper use by the patient must be transmitted by the prescriber. The objective of this thesis work was to investigate the factors associated with the misuse of psychotropic drugs by focusing on situations related to noncompliant prescriptions (by prescribers) and inappropriate uses (by patients). We were interested in psychotropic drugs misused by excess (benzodiazepines and related (BZD/Z) including zolpidem) and by default (clozapine) by combining clinical and epidemiological data. We showed (i) that an unfavorable perception of zolpidem regulation by prescribers was associated with continued non-compliant prescriptions; (ii) that the different drug courses preceding clozapine and the different typologies of patients misusing BZD/Z were associated with the non-application of RBP; finally (iii) that ignorance of the indication for BZD/Z and non-optimal compliance with the initial monitoring of clozapine were associated with inappropriate uses. These results are a reminder of the importance of anticipating risky situations, of the transposability of GPRs to the complexity of patients and of training in pharmacology for prescribers to promote proper use.De par sa fréquence et ses conséquences multiples, le mésusage des traitements psychotropes est un enjeu majeur de santé publique. Qu’il soit lié à une prescription non-conforme ou à un usage inapproprié, l’importance du mésusage peut questionner étant donné que les conditions d’emploi d’un médicament sont règlementées par leur Résumé des Caractéristiques du Produit ainsi que les Recommandations de Bonnes Pratiques (RBP) et son bon emploi par le patient doit être transmis par le prescripteur. L’objectif de ce travail de thèse était d’investiguer les facteurs associés au mésusage des psychotropes en s’intéressant aux situations liées aux prescriptions nonconformes (par les prescripteurs) et aux usages inappropriés (par les patients). Nous nous sommes intéressés à des psychotropes mésusés par excès (benzodiazépines et apparentés (BZD/Z) dont le zolpidem) et par défaut (clozapine) en combinant données cliniques et épidémiologiques. Nous avons montré (i) qu’une perception défavorable de la réglementation du zolpidem par les prescripteurs était associée à une poursuite de prescriptions non-conformes ; (ii) que les différents parcours médicamenteux précédant la clozapine et les différentes typologies de patients mésusant les BZD/Z étaient associées à la non-application des RBP ; enfin (iii) que la méconnaissance de l’indication des BZD/Z et une compliance nonoptimale à la surveillance initiale de la clozapine étaient associées à des usages inappropriés. Ces résultats rappellent l’importance de l’anticipation des situations à risques, de la transposabilité des RBP à la complexité des patients et de la formation en pharmacologie des prescripteurs pour promouvoir le bon usage

Facteurs du mésusage des traitements psychotropes : des prescriptions non-conformes aux usages inappropriés

Due to its frequency and multiple consequences, the misuse of psychotropic treatments is a major public health issue. Whether it is linked to a non-compliant prescription or to inappropriate use, the importance of misuse can be questioned given that the conditions of use of a drug are regulated by their Summary of Product Characteristics as well as the Recommendations of Good Practices (RBP) and its proper use by the patient must be transmitted by the prescriber. The objective of this thesis work was to investigate the factors associated with the misuse of psychotropic drugs by focusing on situations related to noncompliant prescriptions (by prescribers) and inappropriate uses (by patients). We were interested in psychotropic drugs misused by excess (benzodiazepines and related (BZD/Z) including zolpidem) and by default (clozapine) by combining clinical and epidemiological data. We showed (i) that an unfavorable perception of zolpidem regulation by prescribers was associated with continued non-compliant prescriptions; (ii) that the different drug courses preceding clozapine and the different typologies of patients misusing BZD/Z were associated with the non-application of RBP; finally (iii) that ignorance of the indication for BZD/Z and non-optimal compliance with the initial monitoring of clozapine were associated with inappropriate uses. These results are a reminder of the importance of anticipating risky situations, of the transposability of GPRs to the complexity of patients and of training in pharmacology for prescribers to promote proper use.De par sa fréquence et ses conséquences multiples, le mésusage des traitements psychotropes est un enjeu majeur de santé publique. Qu’il soit lié à une prescription non-conforme ou à un usage inapproprié, l’importance du mésusage peut questionner étant donné que les conditions d’emploi d’un médicament sont règlementées par leur Résumé des Caractéristiques du Produit ainsi que les Recommandations de Bonnes Pratiques (RBP) et son bon emploi par le patient doit être transmis par le prescripteur. L’objectif de ce travail de thèse était d’investiguer les facteurs associés au mésusage des psychotropes en s’intéressant aux situations liées aux prescriptions nonconformes (par les prescripteurs) et aux usages inappropriés (par les patients). Nous nous sommes intéressés à des psychotropes mésusés par excès (benzodiazépines et apparentés (BZD/Z) dont le zolpidem) et par défaut (clozapine) en combinant données cliniques et épidémiologiques. Nous avons montré (i) qu’une perception défavorable de la réglementation du zolpidem par les prescripteurs était associée à une poursuite de prescriptions non-conformes ; (ii) que les différents parcours médicamenteux précédant la clozapine et les différentes typologies de patients mésusant les BZD/Z étaient associées à la non-application des RBP ; enfin (iii) que la méconnaissance de l’indication des BZD/Z et une compliance nonoptimale à la surveillance initiale de la clozapine étaient associées à des usages inappropriés. Ces résultats rappellent l’importance de l’anticipation des situations à risques, de la transposabilité des RBP à la complexité des patients et de la formation en pharmacologie des prescripteurs pour promouvoir le bon usage

Cannabinoid Hyperemesis Syndrome Among Pregnant Women: Beyond Diagnosis--Potentially Harmful Consequences.

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Regulatory Framework Implementation for the Prescription of Zolpidem in France, What Impact in the Older People?

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ZORRO: When the mask falls off—Comment

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