[Trend in buprenorphine and methadone shopping behavior in France from 2004 to 2014].
BACKGROUND
The opioid maintenance treatments (OMT) are widely misused and diverted in many countries. Doctor shopping represented the main way to obtain high quantities of opioids in abuse/diversion. The aim of this study was to assess the trends in the prevalence of doctor shopping for high dosage buprenorphine (HDB) and methadone (MTD) from 2004 to 2014 by using the French Health Insurance claims.


METHODS
This was a cross-sectional study of patients treated by OMT (High Dosage Buprenorphine or Methadone) between 2004 and 2014 from a representative sample of the French Health Insurance claims. Doctor shopping was defined as at least 1 day of overlapping prescriptions, written by at least 2 different prescribers and filled in at least 3 different pharmacies.


RESULTS
HDB patients were more likely men (77.9 % in 2014) with a mean age ranged from 33.4±7.6 years in 2004 to 39.5±9.3 years in 2014, P<0.001. MTD patients were also more likely men (73.9 % in 2014) with a mean age ranged from 33.5±6.9 years in 2004 to 37.1±8.5 years in 2014, P<0.001. In 2014, 35 % of HDB patients and 36 % of MTD patients presented a long-term disease which was most frequently a mental health disorders. The prevalence of doctor shopping for HDB decreased from 2004 to 2014 (12.6 % versus 3.9 %, P<0.001). The prevalence of doctor shopping for MTD was very low during the period study (0.2 % to 0.5 %). Overall, the prevalence of doctor shopping was higher for HDB than for MTD whatever the year (P<0.001) of the study.


CONCLUSIONS
Doctor shopping for HDB decreased significantly during the last decade while doctor shopping for MTD remained nearly inexistent even if it could be underestimated because of dispensations in specialized centers and in hospitals not comprised in the insurance claims. The low rates of doctor shopping reported in these last years could result from the guidelines for good practices in OMT use made in 2004 and the adjustments of ANSM (French National Agency for Medicines and Health Products Safety) for HDB best use made in 2011.
CHU de Clermont-Ferrand, centres addictovigilance et pharmacovigilance Auvergne (CEIP-CRPV), service de pharmacologie médicale, BP 69, 63003 Clermont-Ferrand, France.
Mélanie
M
Kernisant
Université d'Auvergne, faculté de médecine, Inserm, UMR 1107 NEURO-DOL, BP 38, 63001 Clermont-Ferrand, France; CHU de Clermont-Ferrand, centres addictovigilance et pharmacovigilance Auvergne (CEIP-CRPV), service de pharmacologie médicale, BP 69, 63003 Clermont-Ferrand, France.
Jessica
J
Delorme
Université d'Auvergne, faculté de médecine, Inserm, UMR 1107 NEURO-DOL, BP 38, 63001 Clermont-Ferrand, France; CHU de Clermont-Ferrand, centres addictovigilance et pharmacovigilance Auvergne (CEIP-CRPV), service de pharmacologie médicale, BP 69, 63003 Clermont-Ferrand, France.
Jean-Luc
JL
Kabore
CHU de Clermont-Ferrand, service de psychiatrie et addictologie, CMPB, BP 69, 63003 Clermont-Ferrand, France.
Georges
G
Brousse
Université d'Auvergne, faculté de médecine, département de médecine générale, BP 38, 63001 Clermont-Ferrand, France.
Catherine
C
Laporte
CHU de Clermont-Ferrand, centres addictovigilance et pharmacovigilance Auvergne (CEIP-CRPV), service de pharmacologie médicale, BP 69, 63003 Clermont-Ferrand, France.
Marie
M
Zenut
Université d'Auvergne, faculté de médecine, Inserm, UMR 1107 NEURO-DOL, BP 38, 63001 Clermont-Ferrand, France; CHU de Clermont-Ferrand, centres addictovigilance et pharmacovigilance Auvergne (CEIP-CRPV), service de pharmacologie médicale, BP 69, 63003 Clermont-Ferrand, France.
Chouki
C
Chenaf
Université d'Auvergne, faculté de médecine, Inserm, UMR 1107 NEURO-DOL, BP 38, 63001 Clermont-Ferrand, France; CHU de Clermont-Ferrand, centres addictovigilance et pharmacovigilance Auvergne (CEIP-CRPV), service de pharmacologie médicale, BP 69, 63003 Clermont-Ferrand, France; CHU de Clermont-Ferrand, centre d'évaluation et de traitement de la douleur (CETD), service de pharmacologie médicale, BP 69, 63003 Clermont-Ferrand, France; Faculté de médecine, institut Analgesia, BP 38, 63001 Clermont-Ferrand, France. Electronic address: nauthier@chu-clermontferrand.fr.
Nicolas
N
Authier
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010818:Practice Patterns, Physicians'; D013997:Time Factors; D055815:Young Adult
D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone