Caroline Victorri-Vigneau

Pharmacoepidemiological characterisation of zolpidem and zopiclone usage

PurposeZolpidem and zopiclone are two widely used non-benzodiazepine hypnotics whose usage seems to be associated to pharmacodependence. However, to our knowledge, there has as yet been no published epidemiological study which has compared their abuse or dependence potential. We used a pharmacoepidemiological approach to identify and characterise zolpidem and zopiclone users in real life situations.MethodsRegular users of zolpidem or zopiclone were identified in the database of a French regional health insurance organisation. A latent class analysis (LCA) was used to identify different subgroups of users of these two hypnotics.ResultsThe study cohort comprised 25,168 patients who regularly used zolpidem and 21,860 who regularly used zopiclone. The results of the latent class analysis, which enables subgroups with similar patterns of response to be identified, revealed four clinical subtypes of users of zolpidem: non-problematic users, users with associations with hypnotics/anxiolytics or with associated mental disorders, and problematic users. Only three subgroups were identified for zopiclone, and LCA did not discriminate a special class of problematic users for this drug.ConclusionOur analysis indicates that there is a subclass of zolpidem user suggestive of abuse; this was not the case for zopiclone. This methodology is very interesting because it allows analysis of databases and determination of a specific signature of drugs potentially leading to abuse or dependence.

An Update on Zolpidem Abuse and Dependence

In 2004, the health authorities (French National Agency for Medicines and Health Products Safety—ANSM) modified the summary of zolpidem characteristics. Particularly it now includes the sentence “a pharmacodependence may materialize.” The current article aims to show that despite this modification, zolpidem continues to be associated with problematic drug use, as the official system (Center for Evaluation and Information on Pharmacodependence—Addictovigilance network) providing information on the abuse and dependence potential of drugs informs us. The authors reviewed the literature on this topic and analyzed French data from zolpidems postmarketing period that were collected by the Addictovigilance network from 2003 to 2010. Postmarketing data and the 30 case reports yielded from the literature review highlight a significant dependence and abuse potential for zolpidem. This survey led to propose in stronger additional rules in France to try to mitigate the abuse potential of zolpidem.

How a novel programme for increasing awareness of health professionals resulted in a 14% decrease in patients using excessive doses of psychotropic drugs in western France

IntroductionConsumption of high doses of psychotropic drugs is a public health problem in France. The Center for Evaluation and Information on Pharmacodependence and the General Health Insurance System decided that it was time to begin a regional programme on excessive consumption in a French region.PurposeThe objectives of this programme were: (1) get health professionals (doctors and pharmacists) to realize that some of their patients were consuming excessive doses, and (2) achieve a decrease of excessive psychotropic drug use. In addition, in the course of the programme, we were able to gather some clinical data related to heavy consumers, and evaluate their possible addiction.MethodThis study is based on data related to 497,821 psychotropic drug consumers. Psychotropic drugs consumers whose consumption had exceeded twice the maximum allowance during at least 3 months in the second half of 2002 were contacted and unless the patients objected, a report on their personal circumstances was sent to their doctor(s) and pharmacist(s). We determined a quantitative method for the assessment of the results.ResultsIncreasing awareness among the health professionals through this original programme resulted in a 14.1% decrease in the percentage of patients receiving excessive doses, a 66% decrease in the number of patients receiving more than twice the maximum recommended dose, among the selected cohort, and some rationalization of consumption as well as a decrease in the “doctor shopping” behaviour.ConclusionsMedical practices did evolve and health professionals became aware of the benefit of their preventive action on the decrease of drug addiction.

Pharmacoepidemiological characterization of psychotropic drugs consumption using a latent class analysis.

France has one of the highest recorded rates of psychotropic use of drugs compared with other European countries, especially for anxiolytics, hypnotics and antidepressants. The aim of this study was to characterize the use of three psychotropic drugs among the most prescribed in France (bromazepam, paroxetine, zolpidem) using reimbursement databases in real-life conditions. Individuals from a region affiliated to the French General Health Insurance Scheme, who had received at least two dispensings of bromazepam, paroxetine or zolpidem reimbursed between 1 January and 30 June 2008, were included. We used a latent class analysis to identify different subgroups of users for these three psychotropic drugs. A total of 40 644 patients were included for bromazepam, 36 264 for zolpidem and 31 235 for paroxetine. Using latent class analysis, four clinical subtypes of users of bromazepam and zolpidem were identified: nonproblematic users, at-risk users, users with a probable mental disorder and compulsive users. Three subgroups were identified for paroxetine that differed rather by the prescription patterns. Users of anxiolytics and hypnotics with at-risk behaviours represented a significant proportion in the studied population. This original method could be extended to other prescription databases to identify populations at risk of abuse or dependence to psychotropic drugs.

Baclofen and Alcohol‐Dependent Patients: A Real Risk of Severe Self‐Poisoning

Baclofen is often prescribed in high doses to fight cravings experienced by alcohol‐dependent patients. Such an increase in the availability of baclofen is concerning. This study aimed to determine the change in number and profile of self‐poisoning with baclofen over time, as baclofen has become increasingly popular, in order to describe the severity of self‐poisoning with baclofen and to focus on co‐existing alcohol use disorders, and psychiatric illnesses determine predictors of severity. This was a retrospective study of self‐poisoning with baclofen as reported by the western France Poison Control Center (PCC), which represents a population of more than 12 million people from January 2008 to March 2014. One hundred and eleven cases of self‐poisoning with baclofen were reported to the western France PCC (62 males and 49 females; average age 39 ± 12). Poisoning severities were as follows: ‘null’ (nine cases), ‘minor’ (37 cases), ‘moderate’ (19 cases) and ‘high’ (46 cases, including four deaths). The most frequently reported symptoms were neurological (45%) and cardiovascular (27%). The severity was significantly associated with psychiatric disorders (OR = 2.9; p = 0.03). Baclofen, prescribed in high doses, may lead to severe poisoning, particularly in patients with psychiatric illnesses. Authorities should put forward a new policy for prescribing the drug as a treatment for alcohol dependence.

Pathological Gambling Associated With Aripiprazole or Dopamine Replacement Therapy: Do Patients Share the Same Features? A Review.

Background In the last 10 years, dopamine replacement therapy (DRT) has become a well-known risk factor for developing an impulse control disorder, such as gambling disorder (GD). Another medication, aripiprazole (ARI), has been more recently identified as another risk factor. Dopamine replacement therapy and ARI share a dopamine agonist action. Our work aimed at comparing patients with PG according to their treatment with DRT or ARI. Methods Two methods were combined—a systematic review concentrated on case reports and the analysis of a French disordered gamblers cohort focused on patients using ARI or DRT at inclusion. Results We reported 48 cases of GD possibly due to DRT and 17 cases of GD possibly due to ARI. Because of their standardized assessment, only the EVALJEU patients could be compared. Two clinical patterns emerged. Patients in the ARI group were young, impulsive, and high novelty seekers and had a history of substance misuse. Their first gambling experience occurred during adolescence. Conversely, patients in the DRT group were old, and they began gambling late in life. They showed low levels of gambling-related cognition. Conclusions Patients in the ARI group seemed to be more severe pathological gamblers than patients in the DRT group. Aripiprazole is a partial D2 receptor agonist, whereas DRT includes full D2 receptor agonist. The trigger mechanism of PG development is complex and cannot only be attributed only to the pharmacodynamic effects of dopaminergic drugs. Indeed, individual vulnerability factors and environmental factors need to be considered.

Benzodiazepines Consumption: Does Dependence Vary with Age?

We have compared two groups of chronic benzodiazepines (or zolpidem/zopiclone) users: “Seniors,” aged 65 years or more, and “Adults,” aged less than 65 years. The study took place in the Pays de Loire region. The questionnaire assesses dependence based on items from the DSM-IV. The analysis was based on 176 Senior questionnaires and 212 Adult questionnaires. Whereas Senior patients take benzodiazepines routinely with little negative consequences, Adults suffer from underlying psychological trouble, mention a higher consumption than planned, which causes negative consequences. 35.2% of Seniors are dependent on benzodiazepines versus 49.8% of Adults.

Diuretic drug therapy monitoring in the elderly: a cohort study

BackgroundBecause the elderly are often treated by multiple-drug regimens, their iatrogenic risks are considerably raised. However, despite the serious side-effects that diuretic agents may have in this population, SPCs (summary of product characteristics) do not specify how often serum chemistry should be monitored. This study of long-term diuretic therapy prescription and monitoring in elderly patients was conducted by the Department of Clinical Pharmacology of the Nantes teaching hospital in collaboration with the medical department of the French national health insurance scheme.MethodsData were extracted from the French national health insurance database. Patients were 75 years old or more and had been receiving a diuretic agent for 1 year or longer. The patients were classified into two groups: one group included those patients whose serum chemistry had been monitored at least once (electrolyte levels and/or urea and creatinine blood levels); the other group included the non-monitored patients.ResultsMean patient age was 80 ± 4.6 (SD) years. The non-monitored patients represented 22.8% of the cohort. The at-risk patients were mainly women suffering from no severe disease, treated by a single practitioner (often a general practitioner) and/or always receiving the same type of diuretic agent.ConclusionMany elderly patients receiving diuretic agents do not benefit from regular serum chemistry monitoring. The prescription of serum chemistry assays is correlated to the presence of various patient-related risk factors. Recommendations should be made to help practitioners to ensure a minimal serum chemistry monitoring in all elderly patients receiving diuretics.

Dependence on Prescription Benzodiazepines and Z-drugs Among Young to Middle-aged Patients in France

Background: Benzodiazepines (BZD) and nonbenzodiazepines hypnotics (z-drugs) are recognized as one of the most widely prescribed medications in the world. Objectives: The purpose of the study was to assess the BZD and z-drugs dependence in young to middle-aged outpatients who were taking BZD/z-drugs on a chronic basis, and to characterize their profile. Methods: This is a forward-looking cross-sectional epidemiological study. Data were collected through a semi-structured interview within a network of partner pharmacies from the Nantes area, in France. All data were obtained exclusively through patients’ declarations. 212 patients (19-64 years old) were included: they were considered dependent when they answered positively to at least three items of the DSM IV. A multivariate logistic regression and a principal component analysis (PCA) were carried out to determine their profile. Results: Almost half of the patients met criteria for BZD/z-drugs dependence. The risk to develop BZD/z-drugs dependence is significantly associated with psychiatric history and with the quantity of BZD/z-drugs that is taken. A two factor concept of dependence could be identified according to the PCA: one axis with items of “tolerance” and “long term administration or higher doses”, and a second axis with “concerned by treatment” and “somatic consequences”. Conclusions/Importance: Among this BZD/z-drug dependent population, the two axes identified in the PCA represent two profiles of dependence: being in positive conditioning or suffering from negative consequences. Clinicians need to know them: these two clinical profiles may have an influence in terms of decision-making, especially to manage discontinuation.

Fortune telling addiction: Unfortunately a serious topic About a case report

Background Constant social change brings about new forms of behavior, such as smartphone use, social networking, indoor tanning, cosmetic surgery, etc., that could become excessive or even lead to new forms of addictive disorders. Methods We report the case of a woman who starts consulting for “clairvoyance addiction”. We then discuss the addictive nature of her disorder, based on several classifications of addiction. Results The patient fulfilled the criteria for addiction and her clinical features were typical of that of addicted people. Other differential diagnoses were discussed. Conclusion As for any addictive behavior, the interaction of several risk factors should be considered. They are related to the individual himself, but also to the object of addiction and to the socio-environmental context. In this case, all the conditions were met for fortune telling use to become addictive.