Centre d'Evaluation et d'Information sur la Pharmacodépendance CEIP PACA-Corse, centre associé, Service de Pharmacologie Clinique, Marseille, France.
CNS Drugs. 2010 Jul;24(7):611-20. doi: 10.2165/11531570-000000000-00000.
Benzodiazepines are widely used for different purposes because of their pharmacological properties, but their abuse potential may represent a limitation to their use. Data suggest that this abuse potential may vary between products and available dosages. Doctor shopping (the simultaneous use of several physicians by a patient) is one of the most important ways in which prescription drugs, in particular benzodiazepines, are diverted.
To assess the potential for abuse of several benzodiazepines using doctor shopping in a French administrative area as a proxy for abuse.
All prescriptions reimbursed during the year 2003 in Haute-Garonne, France (one million inhabitants) for benzodiazepines that were available in ambulatory care through community pharmacies as solid oral forms were extracted from a reimbursement database. The benzodiazepines were alprazolam (0.25 mg, 0.50 mg), bromazepam 6 mg, clonazepam 2 mg, clorazepate (5 mg, 10 mg, 50 mg), diazepam (1 mg, 5 mg, 10 mg), flunitrazepam 1 mg, lorazepam (1 mg, 2.5 mg) and tetrazepam 50 mg. For each patient, the quantities prescribed, dispensed and obtained by doctor shopping (i.e. overlap between prescriptions from different prescribers) were computed. Benzodiazepines were compared using their 'doctor shopping indicator' (DSI, the percentage of each drug obtained through doctor shopping among the total reimbursed quantity).
About 128 000 patients received at least one benzodiazepine during the year. Four groups of benzodiazepines were identified according to their abuse potential: very high abuse potential (flunitrazepam, DSI = 42.8%); high abuse potential (diazepam 10 mg, DSI = 3.2%; clorazepate 50 mg, DSI = 2.7%); intermediate abuse potential (alprazolam 0.50 mg, bromazepam, clonazepam, DSI ranging from 1.8% to 1.9%); and low abuse potential (other benzodiazepines and dosages, DSI ranging from 0.3% to 1.1%).
The DSI can be used to assess the relative abuse liability of benzodiazepines and to detect signals of new patterns of abuse in settings where centralized records of prescription or deliveries are available for the great majority of patients.
由于苯二氮䓬类药物具有药理学特性，因此被广泛用于各种用途，但它们的滥用潜力可能限制了它们的使用。有数据表明，这种滥用潜力可能因产品和可用剂量而异。医生购物（患者同时使用多名医生）是开处方药物（特别是苯二氮䓬类药物）滥用的最重要方式之一。
以法国一个行政区域的医生购物行为来评估几种苯二氮䓬类药物的潜在滥用情况，以此作为滥用的替代指标。
从报销数据库中提取了 2003 年法国上加龙省（一百万居民）开给可通过社区药房获得的口服固体制剂的所有苯二氮䓬类药物的处方。所涉及的苯二氮䓬类药物包括阿普唑仑（0.25 毫克、0.50 毫克）、溴西泮 6 毫克、氯硝西泮 2 毫克、氯氮䓬（5 毫克、10 毫克、50 毫克）、地西泮（1 毫克、5 毫克、10 毫克）、氟硝西泮 1 毫克、劳拉西泮（1 毫克、2.5 毫克）和替马西泮 50 毫克。对于每个患者，计算了处方、配药和医生购物（即不同医生处方之间的重叠）所获得的数量。使用“医生购物指标”（DSI，通过医生购物获得的每种药物占总报销数量的百分比）对苯二氮䓬类药物进行比较。
大约有 128000 名患者在这一年中至少接受了一种苯二氮䓬类药物治疗。根据滥用潜力，将苯二氮䓬类药物分为四组：高度滥用潜力（氟硝西泮，DSI = 42.8%）；高滥用潜力（地西泮 10 毫克，DSI = 3.2%；氯氮䓬 50 毫克，DSI = 2.7%）；中度滥用潜力（阿普唑仑 0.50 毫克、溴西泮、氯硝西泮，DSI 范围为 1.8%至 1.9%）；和低滥用潜力（其他苯二氮䓬类药物和剂量，DSI 范围为 0.3%至 1.1%）。
DSI 可用于评估苯二氮䓬类药物的相对滥用风险，并在集中记录处方或交付情况可用于大多数患者的情况下，发现新的滥用模式信号。
