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

Le rôle du pharmacien d'officine dans la prise en charge des sujets pharmacodépendants

Les problèmes liés à la pharmacodépendance sont aujourd'hui au cœur des débats de santé publique. Les pharmaciens d'officine doivent être des acteurs de santé engagés dans la prise en charge des patients concernés. Or le cadre de la pharmacodépendance (substances psychoactives, modes de consommation, réglementation) est en perpétuelle évolution : un bilan de la situation s'impose. A partir d'un recueil auprès des pharmaciens, nous avons analysé les situations problématiques rencontrées au comptoir. De nombreux acteurs de santé sont impliqués et un partenariat s'avère nécessaire afin d'améliorer la prise en charge des patients et le bon usage des médicaments. Chacun d'entre eux (médecins, Centre de Soin Spécialisé pour les Toxicomanes, Caisse Primaire d'Assurance Maladie, Centre d'Evaluation et d'Information sur les Pharmacodépendances, Conseil de l'Ordre des Pharmaciens) a des attentes et offre des solutions : il convient de définir les missions de chacun et le rôle central du pharmacien d'officine lors de la délivrance des médicaments.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Prospective Study on Factors Associated with Referral of Patients with Opioid Maintenance Therapy from Specialized Addictive Disorders Centers to Primary Care

International audienceBackground: One of the most important issues for opiate maintenance therapy efficacy is the involvement of primary care physicians (PCPs) in opiate use disorder treatment, especially after referral from specialized units. This study aimed to analyze the progress of subjects in a specialized center and after referral to PCPs. Methods: This study was an observational prospective study. Recruitment took place in a specialized addictive disorder center in western France. All patients were evaluated (sociodemographical data, severity of substance use disorders through the TMSP scale, the quality of life through the TEAQV scale) by physicians during the 5-year-follow up of the study. Analysis focused on four main times during follow-up: entry/last visit into specialized care and into primary care. Results: 113 patients were included in this study; 93% were receiving methadone and 7% buprenorphine. Ninety (90) were referred to primary care. In primary care follow-up, the probability of the lowest severity score for substance use disorders remained stable over time. Conclusions: In daily practice, a center specialized in addictive disorders referred OMT management to PCPs for a majority of patients, and benefits regarding substance use disorders severity and quality of life remained stable after referral. Our results need to be confirmed

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

International audienc

ZORRO: When the mask falls off—Comment

International audienc

Cathinone Use Disorder in the Context of Slam Practice: New Pharmacological and Clinical Challenges

Background: "Slam" has emerged since 2008 as a new international phenomenon among men who have sex with men (MSM); it consists of the intravenous injection of drugs before or during planned sexual activity. The practice of slam is associated with the use of psychostimulants, including synthetic cathinones.Methods: All spontaneous notifications (Nots) of slam practice reported between January 2012 and October 2019 at the Nantes addictovigilance center in France were collected and analyzed. The purpose of this work was to analyze cases of slam to characterize cathinone use disorder according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and to further our knowledge of slam practice based on data on drug use, risk taking and harmful consequences.Results: We collected 39 slam Nots. The severity of cathinone use disorder was mild, moderate and severe for 18%, 12%, and 58% of the patients, respectively. "Much time spent using cathinone" was the diagnostic criterion most often cited (82%).Conclusions: To the best of our knowledge, our study is the first to evaluate the presence of a cathinone use disorder. Cathinone use disorder seems particularly important in this population of users, and negative consequences of slam practice appear quickly

Medicated or Not Medicated Hypnotic Substance Use: Strategies in Sleep Disorders among Patients of Community Pharmacy

International audienceThe principal outcome was to identify which hypnotics substances, medicated (benzodiazepines, antihistamine, antidepressant\ldots ) or not medicated (herbal medicine, homeopathy, melatonin\ldots ), were consumed by community pharmacy patients who reported taking something for sleep disorder, and which factors can influence the consumption of medicated substance rather than nonmedicated substance. Data were collected via a network of 73 partner pharmacies around Nantes, France. Patients who reported taking a substance to sleep completed a questionnaire that collected data relative to the different substances consumed by that person for sleep, and the desired effect. Substances were classified in Hypnotic Drug Substances and nonmedicated hypnotic substances. A logistical regression was done in order to highlight the factors associated with the consumption of Hypnotic Drug Substance rather than nonmedicated hypnotic substances. Six hundred and forty-seven patients were included, with an average age of 58 years and 74% female. The principal strategy employed to combat sleep disorder was the consumption of Hypnotic Drug Substance (54%), followed by herbal medicine (32%) and homeopathy (19%). The factors positively associated with the consumption of a Hypnotic Drug Substance are age, living alone, being out of work, or in the process of looking for a job and being a parent. In our survey, the use of Hypnotic Drug Substance to help patients with sleep is far from systematic. On the other hand, among patients who consume HDS, misuse is still significant, particularly in terms of the duration of consumption