Evidence of slow-release morphine sulfate abuse and diversion: epidemiological approaches in a French administrative area.
Slow-release oral morphine sulfate (SM) is one of the most abused prescription opioids in France. However, the regional feature of the abuse of morphine is poorly documented. To investigate the abuse of SM in a French administrative region, a multisource approach was applied. The first approach was based on SM exposition at national and regional level using the OPPIDUM survey. In a second approach, we analyzed a drug reimbursement database to assess the magnitude of SM abuse in Languedoc-Roussillon (LR) region. A clustering method was applied to classify patients and to describe the profile of deviant patients. The third approach was based on a self-administered anonymous questionnaire, proposed to patients seen in addiction care centers in the LR region and consuming oral SM. The OPPIDUM study showed that in most regions, where the prevalence of heroin use is higher than the national average of 9.1%, SM consumers were fewer. With the clustering method, three subgroups were identified. One of them gathered 35 users (3.2%) with a deviant behavior characterized by significantly more dispensations, dispensing pharmacies, and prescribers. These subjects were mainly men, younger, and more consumers of benzodiazepines and opioid maintenance therapy than the others. The third study allowed specifying that SM was mainly injected (93.7%), bought in the street (80%), and used because of unavailability and the poor quality of heroin (33.9%). The three proposed approaches are complementary and help to clarify the abuse of oral SM, while assessing the motivations of this abuse.
Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance, Département de Pharmacologie Médicale et Toxicologie, CHRU Montpellier, F-34295, Montpellier, France. h-peyriere@chu-montpellier.fr.
Hélène
H
Peyriere
Unité de recherche clinique et épidémiologique, Département de l'Information Médicale, Hôpital La Colombière, CHRU Montpellier, F-34295, Montpellier, France.
Erika
E
Nogue
Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance, Département de Pharmacologie Médicale et Toxicologie, CHRU Montpellier, F-34295, Montpellier, France.
Céline
C
Eiden
Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance Paca Corse, Service de Pharmacologie Clinique et Pharmacovigilance, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France.|UMR 7289 Aix Marseille Université-CNRS, Institut des Neurosciences Timone, secteur PiiCi, F-13005, Marseille, France.
Elisabeth
E
Frauger
Echelon Régional du Service Médical, Caisse nationale d'Assurance Maladie des Travailleurs Salariés, F-34967, Montpellier, France.
Maryline
M
Charra
Unité de recherche clinique et épidémiologique, Département de l'Information Médicale, Hôpital La Colombière, CHRU Montpellier, F-34295, Montpellier, France.
Marie-Christine
MC
Picot
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D009021:Morphine Dependence / Q000175:diagnosis / Q000453:epidemiology*; D060735:Pharmacovigilance; D064226:Prescription Drug Diversion / Q000517:prevention & control / Q000639:trends*; D016320:Substance Abuse Treatment Centers / Q000639:trends; D011795:Surveys and Questionnaires; D055815:Young Adult
D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D009020:Morphine
drug abuse; opioid-related disorders; slow-release oral morphine sulfate