Centre d'Evaluation et d'Information de la Pharmacodependance-Addictovigilance PACA-Corse, hôpital Timone, Pharmacologie clinique, Institut des Neurosciences de la Timone, Faculté de médecine, Aix Marseille Université UMR 7289 CNRS, Marseille, France.
Pain Physician. 2013 Jan;16(1):89-100.
Prescription opioid abuse is not homogeneous due to varying patterns of use and different geographic preferences. Because doctor shopping is one of the main sources of diversion, it has previously been used to estimate drug abuse.
The aim of this study was to describe and compare opioid abuse in 2008 using doctor shopping to estimate abuse in 3 French regions.
Data for this study came from the General Health Insurance (GHI) reimbursement database, which covers 77% of the French population. All individuals living in Provence-Alpes-Cote d'Azur-Corse (PACA), Rhone-Alpes (RA), or Midi-Pyrenees (MP) that received at least one reimbursement for oral opioids from the GHI in 2008 were included.
Oral opioids under study were opioids for mild to moderate pain (dextropropoxyphene, codeine, tramadol, dihydrocodeine), opoids for moderately severe to severe pain (oral morphine, oxycodone, buprenorphine painkiller, hydromorphone), and opioid maintenance treatments (buprenorphine maintenance, methadone). For a given opioid, the Doctor Shopping Quantity (DSQ) is the quantity obtained by overlapping prescriptions from several prescribers. It is used to estimate the magnitude of abuse. The Doctor Shopping Indicator (DSI) is the DSQ divided by the total dispensed quantity. It is used to estimate the abuse corrected for use.
The total DSQ for opioids in PACA (213.3 DDD/1,000 inhabitants) was twofold superior to that in RA (115.1 DDD/1,000) and in MP (106.2 DDD/1,000). The DSQ of opioids for mild to moderate pain was 75.5DDD/1000 (DSI=1.1%), 19.7DDD/1,000 (DSI=5.0%) for opioids for moderately severe to severe pain, and 55.3DDD/1,000 (DSI=6.2%) for opioid maintenance treatments. Emergent signals of abuse have been observed at a regional level for oxycodone in MP and dihydrocodeine in RA and MP.
The main limitation of this study is that the GHI reimbursement database provides information about dispensed and reimbursed prescription drugs, and not necessarily the actual quantity used.
These results confirm important variations in the 3 French regions despite them being geographically close. Besides, they highlight different rates of opioid abuse between opioids for mild to moderate pain, opioids for moderately severe to severe pain, and opioid maintenance treatments, as well as differences within these groups.
由于使用模式和不同地域偏好的不同，处方类阿片滥用情况并不统一。由于“医生购物”是药物滥用的主要来源之一，此前曾被用于估计药物滥用情况。
本研究旨在描述和比较 2008 年使用“医生购物”估计法国三个地区阿片类药物滥用情况。
本研究的数据来自于全民健康保险（GHI）报销数据库，该数据库覆盖了法国 77%的人口。2008 年，普罗旺斯-阿尔卑斯-蓝色海岸（PACA）、罗纳-阿尔卑斯（RA）或米迪-庇里牛斯（MP）地区居住的、通过 GHI 报销至少一种口服类阿片药物的所有个人均被纳入研究。
研究中使用的口服类阿片药物包括轻中度疼痛的阿片类药物（右丙氧芬、可待因、曲马多、二氢可待因）、中重度疼痛的阿片类药物（口服吗啡、羟考酮、丁丙诺啡止痛药、氢吗啡酮）和阿片类药物维持治疗（丁丙诺啡维持治疗、美沙酮）。对于特定的阿片类药物，“医生购物量”（DSQ）是从多个处方重叠获得的数量。它用于估计滥用程度。“医生购物指标”（DSI）是 DSQ 除以总分发数量。它用于估计纠正使用情况后的滥用情况。
PACA 的总 DSQ 为 213.3 DDD/1000 居民，是 RA（115.1 DDD/1000）和 MP（106.2 DDD/1000）的两倍。轻中度疼痛的阿片类药物的 DSQ 为 75.5DDD/1000（DSI=1.1%），中重度疼痛的阿片类药物的 DSQ 为 19.7DDD/1000（DSI=5.0%），阿片类药物维持治疗的 DSQ 为 55.3DDD/1000（DSI=6.2%）。在 MP 的羟考酮和 RA 和 MP 的二氢可待因方面，已经观察到区域性滥用的紧急信号。
本研究的主要限制是 GHI 报销数据库提供了有关分发和报销处方药物的信息，而不一定是实际使用的数量。
尽管这三个地区在地理位置上接近，但这些结果仍证实了它们之间存在重要差异。此外，它们突出了轻中度疼痛的阿片类药物、中重度疼痛的阿片类药物和阿片类药物维持治疗之间的滥用率不同，以及这些组内的差异。
