Orriols Ludivine, Gaillard Julia, Lapeyre-Mestre Maryse, Roussin Anne
Unité de Pharmacoépidémiologie, EA 3696 Université de Toulouse, Toulouse, France.
Drug Saf. 2009;32(10):859-73. doi: 10.2165/11316590-000000000-00000.
Drugs that can be obtained without a medical prescription in community pharmacies are used to treat minor pathologies that can easily be diagnosed by the patient. Some of these drugs contain psychoactive substances with a potential for abuse and dependence. However, there is a lack of data concerning their problematic use in a wide population.
To explore the feasibility of a pharmacoepidemiological method to investigate misuse, non-medical use, abuse and dependence on drugs used for self-medication.
This cross-sectional pilot study, conducted during a 2-month period (from 15 January to 15 March 2007), was based on the participation of community pharmacies in the Midi-Pyrénées region of France to collect patient data. Patients requesting one drug from a list of available drugs used for self-medication and containing psychoactive substances (codeine in analgesics, pseudoephedrine, dextromethorphan and histamine H(1) receptor antagonists [antihistamines]) were included in the study. A control group was set up that consisted of patients requesting antacid drugs. The pharmacy staff proposed to the patients that they filled in an anonymous questionnaire. The questionnaire was designed to investigate patterns of drug use and the harmful consequences of overuse (abuse). In addition, questions on lack of control over drug use were adapted from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for evaluation of dependence.
Thirty-two percent (n = 74) of the solicited pharmacies participated in the survey. Only 4.8% of the solicited patients (n = 817) refused to complete the questionnaire distributed by the pharmacy staff. The questionnaire was completed inside the pharmacy by 53.3% of the patients. The other patients took the questionnaire away from the pharmacy and 31.7% of them returned it in a prepaid envelope. The patient participation rate was 64.9%, and was higher for the psychoactive substance groups than the control group. Statistically significant differences on misuse (and/or non-medical use), abuse and dependence were obtained between the codeine and antacid groups. In the codeine group, among the patients having used the product in the previous month (n = 53), 15.1% misused the drug and/or used the drug for a non-medical reason, 7.5% were cases of abuse and 7.5% presented criteria of lack of control over drug use related to dependence on the substance for the psychoactive effects or for pain relief.
The results obtained in this pilot study indicate that using anonymous self-administered questionnaires offered to patients by pharmacy staff is a reliable method to obtain information on the problematic use of drugs containing psychoactive substances purchased in a pharmacy for self-medication.
在社区药店无需医生处方即可购得的药物，用于治疗患者可轻易自我诊断的轻微病症。其中一些药物含有具有滥用和成瘾潜力的精神活性物质。然而，目前缺乏关于这些药物在广大人群中存在问题使用情况的数据。
探讨采用药物流行病学方法调查自我药疗药物的误用、非医疗使用、滥用和成瘾情况的可行性。
这项横断面试点研究在2个月期间（2007年1月15日至3月15日）进行，基于法国南部-比利牛斯地区社区药店参与收集患者数据。从用于自我药疗且含有精神活性物质（镇痛药中的可待因、伪麻黄碱、右美沙芬和组胺H(1)受体拮抗剂[抗组胺药]）的可用药物清单中索取一种药物的患者纳入研究。设立了一个由索取抗酸药物的患者组成的对照组。药店工作人员建议患者填写一份匿名问卷。该问卷旨在调查药物使用模式以及过度使用（滥用）的有害后果。此外，关于药物使用失控的问题改编自《精神疾病诊断与统计手册》第4版（DSM-IV）中评估成瘾的标准。
32%（n = 74）的被征求意见的药店参与了调查。在被征求意见的患者中，只有4.8%（n = 817）拒绝填写药店工作人员分发的问卷。53.3%的患者在药店内完成了问卷填写。其他患者将问卷带出药店，其中31.7%的患者通过预付信封寄回。患者参与率为64.9%，精神活性物质组的参与率高于对照组。可待因组和抗酸剂组在误用（和/或非医疗使用）、滥用和成瘾方面存在统计学显著差异。在可待因组中，在上个月使用过该产品的患者（n = 53）中，15.1%误用了该药物和/或出于非医疗原因使用该药物，7.5%存在滥用情况，7.5%表现出与因精神活性作用或止痛而对该物质成瘾相关的药物使用失控标准。
这项试点研究获得的结果表明，使用药店工作人员向患者提供的匿名自填问卷是获取关于在药店购买用于自我药疗的含精神活性物质药物存在问题使用情况信息的可靠方法。
