LE CRACK. ASPECTS ANALYTIQUES, BIOLOGIQUES, CLINIQUES ET MEDICO-LEGAUX

DEPUIS QUELQUES ANNEES, PLUSIEURS SOURCES INDEPENDANTES METTENT EN EXERGUE L'AUGMENTATION DE LA CONSOMMATION DE CRACK AUX ANTILLES CORROBORANT NOTRE PROPRE EXPERIENCE AU CHU DE POINTE A PITRE. L'OVERDOSE RESTANT EXCEPTIONNELLE, LA TOXICOMANIE AU CRACK CONDUIT A UNE HOSPITALISATION D'ENVIRON 100 MALADES PAR AN. EN DEHORS D'ARTICLES DE DESCRIPTION A PROPOS D'UNE COMPLICATION PRECISE ON NE RETROUVE PAS DANS LA LITTERATURE D'ETUDE CLINIQUE SUR LA PREVALENCE DES EFFETS CLINIQUES SECONDAIRES A LA TOXICOMANIE AU CRACK. EN COLLABORATION AVEC L'INSTITUT MEDICO-LEGAL DE STRASBOURG, NOUS AVONS MIS AU POINT UNE TECHNIQUE DE DOSAGE (GC/MS) DE LA COCAINE, DE SES METABOLITES PRINCIPAUX ET DU PRODUIT DE PYROLYSE DE LA COCAINE BASE (SPECIFIQUE CONSOMMATION DE CRACK) : L'ANHYDROECGONINE METHYLESTER, DANS L'URINE, LA SALIVE, LA SUEUR ET LES CHEVEUX. DISPOSANT AINSI DES OUTILS NOUS PERMETTANT D'EFFECTUER LE DIAGNOSTIC BIOLOGIQUE DE CETTE TOXICOMANIE AVEC UNE LARGE FENETRE DE DETECTION, NOUS AVONS ETUDIE LA FREQUENCE RELATIVE DES CARACTERISTIQUES CLINIQUES DE L'INTOXICATION AIGUE ET CHRONIQUE AU CRACK. CETTE ENQUETE CAS-TEMOINS, PLURIDISCIPLINAIRE, D'UNE DUREE DE 18 MOIS A CONDUIT A L'INCLUSION DE 119 PATIENTS : 78 CONSOMMATEURS DE COCAINE SOUS FORME FUMEE (CRACK+) ET 41 CONSOMMATEURS DE COCAINE (COC+) SOUS FORME SNIFFEE OU INJECTEE. LA FREQUENCE DES HOSPITALISATIONS A ETE SIGNIFICATIVEMENT PLUS IMPORTANTE CHEZ LES CRACK+ QUE CHEZ LES COC+. POUR 36% DES CRACK+, L'HOSPITALISATION EST CONSECUTIVE A UNE CONDUITE A RISQUE. LES AUTRES MOTIFS D'HOSPITALISATION PEUVENT ETRE ASSOCIES A L'USAGE DE LA COCAINE MAIS NE SONT PAS SPECIFIQUES DE LA CONSOMMATION DE CRACK, SEULE LEUR FREQUENCE APPARAIT LIEE AU MODE DE CONSOMMATION. LA CHRONICITE DE L'INTOXICATION AU CRACK APPARAIT PLUS DANGEREUSE QUE LE RISQUE DE SURDOSAGE. LA MORTALITE DE CETTE TOXICOMANIE EST FAIBLE, MOINS DE 2%, LES PARTICULARITES MEDICO-LEGALES SONT PEU SPECIFIQUES. LES CONSEQUENCES SOCIALES DE LA TOXICOMANIE AU CRACK APPARAISSENT PLUS NETTEMENT AVEC UNE EXPOSITION A DES COMPORTEMENTS A RISQUE ET LA CLOCHARDISATION DE SUJETS JEUNES. LES IMPLICATIONS LEGALES DE CETTE TOXICOMANIE SONT CERTAINES COMME EN TEMOIGNENT LE NOMBRE DE DECES POUR CAUSE TRAUMATIQUE CONSECUTIFS A UNE RIXE ET LES CHIFFRES TRADUISANT L'AUGMENTATION DE LA CRIMINALITE AUX USA ET DANS LA CARAIBE.POINTE A PITRE-BU (971202101) / SudocSudocFranceF

Trends in Fatal Poisoning Among Drug Users in France From 2011 to 2021

Importance The DRAMES (Décès en Relation avec l’Abus de Médicaments Et de Substances) register is a database of drug-related deaths with the aim of identifying the psychoactive substances associated with and estimating the trends in these deaths. Our novel approach is based on the collection of data on all deaths for which toxicology experts have performed analyses. Objective To describe drug-related deaths in France and report trends over an 11-year period. Design, Setting, and Participants This case series used a national register to assess 4460 drug-related deaths that occurred from 2011 to 2021 in France. Data analyses were performed from January 1, 2012, to December 31, 2022. Main Outcomes and Measures Demographic characteristics; medical and substance abuse history; forensic autopsy findings; and toxicology reports. Results Among the 4460 deceased individuals (mean [SD] age, 37.8 [10.5] years), the mortality rate was highest among men (sex ratio, 4.4:1). Of the deaths involving a single or predominant drug, the legal substitution product, methadone, was the leading cause of death during the entire study period, ahead of heroin—44.7% and 35.9% for methadone vs 15.8% and 21.8% for heroin in 2011 and 2021, respectively. Between 2011 and 2021, most of the drug-related deaths shifted from licit to illicit drugs, and statistically significant variations were found for buprenorphine, cocaine, heroin, methadone, and other licit opioids. Deaths related to polydrug use increased from 23.2% in 2011 to 30.6% in 2021. In this context, opioids remained associated with most deaths, with at least 1 opioid being involved in approximately 9 of 10 cases (85.9%) in 2021. However, the main trend was the dramatic increase in drug combinations with cocaine, from less than one-third of cases in 2011 (30.8%) to more than half in 2021 (57.8%). Conclusions and Relevance This case series assessment of 4460 drug-related deaths found that opioids used alone or in combination were the main contributor to drug-related deaths, despite having a lower prevalence than other drugs. This finding is similar to that of other countries; however, in France licit methadone was the leading cause of opioid-related deaths (ahead of heroin) during the study period. Deaths associated with use of cannabis, new psychoactive substances, and stimulants (including amphetamine-type stimulants and cocaine, especially in combination) have increased and should be closely monitored