Search

The use of nefopam is constantly increasing in France. The objectives of this study were to quantify the intensity of the drug dependence signal, to identify the populations at risk and the risk factors of dependence.All serious and non-serious cases of misuse, abuse, drug dependence, overdose and withdrawal syndrome reported to the French Addictovigilance Network since 1988 were reviewed. An analysis of nefopam reimbursement data from the French national EGB (échantillon généraliste des bénéficiaires) database for the period 2006-2017 was also performed.The drug dependence profile of nefopam is close to that of a psychostimulant. Our literature review and the analysis of spontaneous reports confirm the risk of abuse and dependence of nefopam. In addition to a frequent psychiatric history (depression, psychosis, anxiety), nearly half of the patients also present addictive disorders, including more than one-third with opioid-dependence. In almost half of the 120 reported cases, the main adverse reaction was dependence and the frequency of serious effects was greater than 40%. In nearly 70% of the reported cases, the use was associated with chronic pain, which might explain the prolonged use. Moreover, the analysis of data on the reimbursement of nefopam in the general population showed that one French person out of two, having a prescription for nefopam, presented chronic pain. However, nefopam is only indicated in the treatment of acute painful conditions. Although it does not seem to be associated with a greater risk of abuse or dependence, taking the drug orally is another very frequent off-label use that needs to be regulated.In France, the prescription of nefopam outside of its marketing authorization is regrettable, because it contributes to the development of abuse and drug dependence.

International audience; A great diversification of drugs of abuse has been observed in recent years, both in the populations using them and in the types of drugs. Although dependency and psychiatric disorders associated with the abuse of these substances is well known, somatic complications, uro-nephrotoxicity in particular, are less recognized. We propose here an overview of the products used by drugs abusers in France, through the analysis of the national pharmaco-epidemiological study Observation des produits psychotropes illicites ou détournés de leur utilisation médicamenteuse (OPPIDUM). Among the 5003 patients who participated in this survey, 84% were on prescribed psychoactive substances, with indicators of abuse in 28% of cases; more than half of these patients had also been using drugs of abuse (mainly cannabis) in the previous week. We then describe the main urological and renal toxicities of these drugs, in particular of heroin, cocaine, cannabis, ecstasy, LSD, amphetamine, new designer drugs, ketamine and opiate substitution treatment. We finally present a pharmaco-epidemiological survey of patients hospitalized for drugs complications in nephrology at the university hospital of Marseille. Between 2000 and 2015, 22 patients aged 18 to 57 years were hospitalized for renal adverse effects of drugs of abuse, such as glomerulonephritides, focal segmental glomerulosclerosis, acute kidney injury or chronic kidney disease. The somatic complications of drugs participate in their dangerousness and should be a red flag. They should be systematically reported to the addictovigilance national network to allow the improvement of information given to the patients and the medical community, and to adapt the prevention and risk reduction policies.; L’abus de substances psychoactives (SPA) s’est diversifié ces dernières années, tant au niveau des populations concernées que des produits consommés. Si la dépendance et les troubles psychiatriques liés à la consommation de ces substances sont généralement connus, les complications somatiques, en particulier uro-néphrologiques, le sont moins. Nous proposons tout d’abord dans cette revue un état des lieux des SPA consommées par les usagers de drogue en France, à partir des données de l’étude nationale pharmaco-épidémiologique OPPIDUM (Observation des produits psychotropes illicites ou détournés de leur utilisation médicamenteuse). Parmi les 5003 patients interrogés, 84 % étaient consommateurs d’au moins une SPA médicamenteuse, avec des indicateurs d’abus dans 28 % des cas, et plus de la moitié avaient consommé une SPA non médicamenteuse (principalement du cannabis) la semaine précédente. Nous décrivons ensuite les complications urologiques et néphrologiques des principales SPA, telles que l’héroïne, la cocaïne, le cannabis, l’ecstasy, le LSD, les amphétamines, les nouveaux produits de synthèse, la kétamine et les médicaments de substitution aux opiacés. Nous présentons enfin une enquête pharmaco-épidémiologique concernant les patients hospitalisés en néphrologie adulte au CHU de Marseille pour des complications liées à l’abus de SPA. Entre 2000 et 2015, 22 patients âgés de 18 à 57 ans ont été hospitalisés pour des complications néphrologiques des SPA, telles que glomérulonéphrite aiguë, hyalinose segmentaire et focale, insuffisance rénale aiguë ou chronique. Les complications somatiques liées à l’usage des SPA participent à leur dangerosité et peuvent avoir une valeur d’alerte. Il est important que les professionnels de santé signalent au centre d’addictovigilance de leur territoire les complications sanitaires liées à l’usage des SPA, afin d’optimiser l’information donnée aux patients et aux professionnels de santé et d’adapter des programmes de prévention et de réduction des risques.

A great diversification of drugs of abuse has been observed in recent years, both in the populations using them and in the types of drugs. Although dependency and psychiatric disorders associated with the abuse of these substances is well known, somatic complications, uro-nephrotoxicity in particular, are less recognized. We propose here an overview of the products used by drugs abusers in France, through the analysis of the national pharmaco-epidemiological study Observation des produits psychotropes illicites ou détournés de leur utilisation médicamenteuse (OPPIDUM). Among the 5003 patients who participated in this survey, 84% were on prescribed psychoactive substances, with indicators of abuse in 28% of cases; more than half of these patients had also been using drugs of abuse (mainly cannabis) in the previous week. We then describe the main urological and renal toxicities of these drugs, in particular of heroin, cocaine, cannabis, ecstasy, LSD, amphetamine, new designer drugs, ketamine and opiate substitution treatment. We finally present a pharmaco-epidemiological survey of patients hospitalized for drugs complications in nephrology at the university hospital of Marseille. Between 2000 and 2015, 22 patients aged 18 to 57 years were hospitalized for renal adverse effects of drugs of abuse, such as glomerulonephritides, focal segmental glomerulosclerosis, acute kidney injury or chronic kidney disease. The somatic complications of drugs participate in their dangerousness and should be a red flag. They should be systematically reported to the addictovigilance national network to allow the improvement of information given to the patients and the medical community, and to adapt the prevention and risk reduction policies.

Methylenedioxymethamphetamine (MDMA), the active compound of ecstasy, has been used for several years, especially by young adults to benefit of psychostimulant properties. By raising the level of neuromodulators in the synapsis, MDMA can cause psychiatric and physical injuries. After reduced supplies in 2009 (number of ecstasy seizures equal to 10 percent of those recorded in 2002), judicial authorities now observed an increased availability (a half more part of seizures in 2012 than 2010). From its "Spontaneous Notifications" data base and "deaths in connection with the abuse of medicine and substances (DRAMES)", "observation of illegal drugs and misuse of psychotropic medications" (OPPIDUM), and "observation of drug dependencies in ambulatory medicine" (OPEMA) national inquiries, the French Addictovigilance network (CEIP-A) highlighted the increasing consumption of MDMA. The way of use appeared quite unchanged: users were mainly young men between 25 and 30 years; they favored an occasional use but mainly combined other products such as alcohol, cannabis and other stimulants. Severity of the clinical cases, based on hospital care and forensic data, could be consistent with the higher amounts of MDMA measured in pills.

To assess the frequency and severity of accidental cannabis poisoning in children.A retrospective study of cases of accidental cannabis poisoning in people aged under 18 years old, reported to the Marseille poison center from 1993 through 2007. We excluded cases where cannabis was definitively ruled out, and neonatal withdrawal syndromes in newborns from cannabis users.We collected 93 cases, including 56 boys and 37 girls, 86% of whom were younger than 3 years. The principal form was cannabis resin (hashish), reported in 80% of the cases and belonging to one of the parents or a household member. In almost all cases, the poisoning took place at the child's home. The frequency has risen in recent years, with 2/3 of the cases occurred in the second half of the study period. Five serious cases were reported, two with convulsions.Considering the observed increase in cases each year, mostly benign but potentially serious, prevention and information efforts have to be improved for drug users with young children and for healthcare professionals led to manage this kind of accident.

The abuse of licit and illicit psychoactive substances in children and teenagers represents a public health problem.The aim of this study was to evaluate the extent of this phenomenon and its growth in the PACA (Provence-Alpes-Côte d'Azur) region (Southeastern France). The cases identified during the 10-year period 1992-2002 by the CEIP (Centre d'Evaluation et d'Information sur la Pharmacodépendance) were studied retrospectively.One hundred and ninety-one cases were identified. In most instances, abuse involved a first experience or was sporadic. The users were often boys (70%). The substances were solvents (48.7%) used collectively (33%) during recreational activities (74%). Illicit drugs accounted for 28.2% of the cases involving a first experience (89%), with polyconsumption accounting for 50%, cannabis 57.6%, ecstasy 25.9%, and LSD (lysergic acid diethylamide) 12.1% of cases. Medicines were also used (16%), the most frequent being benzodiazepines (51.6%).The study confirms the abuse of licit and illicit psychoactive substances in children and teenagers and provides information regarding the substances available in this region of France.

Ketamine is an anaesthetic used in human medicine and veterinary practice, synthesised on 1962 and marketed on 1970 in France. Recreational uses were described during 1992 in the medical community and in 1996 in the dance settings. The chemical name of ketamine is 2--(2chlorophenyl)2-(methylamine)-cyclohexanone, an aryl cyclohexylamine, structurally related to phencyclidine. Ketamine is known under the following street names: Keta K, Kate, Special K, Vitamin K, la Golden, la Vétérinaire. Ketamine is used intranasally, orally and intramusculary in recreational use. Ketamine is manufactured by the chemical industry. Due to the complicated synthesis, it is sold illicitly for recreational use. Ketamine is a dissociative drug, and the user enters in a psychedelic dream with hallucinations, floating sensation, feeling of dissociation of the mind from the body. The dream is forgotten, the user full in reality with loss of self control, risk of acute intoxication. In long-term exposure, tolerance, dependence, withdrawal signs and flash back are described. Ketamine trademarks are subject to control in France through medicine legislation Ketamine and its salts are subject to control under the national legislation on narcotics and psychotropics substance. From September 2001, the theft of medical and veterinary trademarks have to be declared to police, care health authority Pharmacy control authority and French Health Products Safety Agency.

Dietary supplements containing Ma Huang (chinease ephedra) are available on the web sites and dietary shops in USA. They are widely promoted and used as a mean of weight reduction and energy enhancement. They contain Ma Huang alone or combined with Guarana (caffeine), creatine, St John's wort, carnitine and are proposed with different labels. Numerous reports of adverse reactions and acute intoxication related to these products use were described in the medical literature. In the light of the severity of these cases, some of which resulted in permanent injury and death, the Food and Drug Administration has proposed limits on the dose and duration of use of such supplements. A review of 140 reports submitted to the FDA between June 1997 and March 1999, 47% involved cardiovascular symptoms, 18% neurological symptoms. Severe hypertension was the single most frequent adverse effect followed by tachycardia, myocardial infarction, stroke, seizure. Ten events resulted in death and 13 produced permanent impairment. In France, ampleness of the use of dietary supplements containing ephedra alkaloids is unknown. Two French recent severe poisonings (one with "ripped Fuel" for losing weight and the other with "Energy pills" in a body builder) show that there is serious health risks for the chronic users. Dietary supplements are not subject to control under "la Direction Générale de la Santé". Informations for general public, medical community and health-care authorities are necessary to be aware of potential health hazards of these products use.

To study the doping substances used in sport and their toxicity.Retrospective analysis from January 1992 to December 2000 of the cases of use of doping substances in sport reported by telephone to the anti-poison center in Marseilles.Fifty-one cases were reported concerning 48 men and 3 women with a mean age of 30, ranging from 10 to 55 years. Sixty-three percent of cases were reported over the last four years. The sport practiced was bodybuilding, except in 2 cases (cycling in one case and running in the other). The products used were mainly anabolizing hormones (15 times), clenbuterol (14 times) and creatine (7 times). A third of cases concerned associations of substances and 19 cases presented with symptomatology.The diversity in nature and status of the substances mentioned and their association requires enhanced vigilance with regard to the use of drugs in sport. The recent measures voted within the framework of the anti-doping law dated 23/3/99 are aimed at increasing surveillance with the development of anti-doping antennae.

To evaluate the frequency and severity of accidental poisoning in children by narcotics or buprenorphine, a retrospective study was carried out: 75 cases were collected by the Marseille Poison Centre between 1993 and 1999. Most of the patients were between 1 and 3 years old and the drugs involved were cannabis and, more recently, Subutex (buprenorphine). These two drugs were responsible for the most severe cases of poisoning, most of which occurred at home.

Products used in a toxicomaniac way are in rapid change, and different from different area. Users too have to be better known. Authors present a simple survey method of these products, based on sample use. First results seem to be correct. These method may be used, associated with others, in a network as those existent for many years in the United States.