Jouanjus Emilie, Guernec Grégory, Lapeyre-Mestre Maryse
Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, 37, Allées Jules Guesde, 31000, Toulouse, France.
Department of Medical and Clinical Pharmacology, Addictovigilance Center, Toulouse University Hospital, 37, Allées Jules Guesde, 31000, Toulouse, France.
Fundam Clin Pharmacol. 2018 Jun;32(3):306-322. doi: 10.1111/fcp.12356. Epub 2018 Apr 2.
Diversion of prescription drugs is difficult to assess in quality and quantity. This study aimed to characterize diversion of prescription drugs in France through a comparative analysis of falsified prescriptions collected during three periods from 2001 to 2012. The data recorded in a national program which records all falsified prescriptions presented to community pharmacies were studied. Included data regarded: subjects, prescription forms, and drugs. Description of the dataset in three periods (2001-2004, 2005-2008, and 2009-2012) was completed with clustering analyses to characterize profiles of prescriptions and subjects associated with the most reported drugs. The 4469 falsified prescriptions concerned most often females (51.6%). Average age was 46.5 years. Zolpidem, bromazepam, and buprenorphine were the most frequent drugs. Alone, 13 drugs (1.7%, 13/772) represented more than 40% of the total reports (3055/7272). They were associated with three diversion profiles: (i) buprenorphine, flunitrazepam, and morphine were mentioned on overlapping secure prescription forms presented by young men; (ii) alprazolam, bromazepam, zolpidem, codeine/acetaminophen were mentioned on simple prescription forms presented by experienced women; and (iii) acetaminophen and lorazepam were mentioned on modified prescription forms presented by elderly subjects. Clonazepam, clorazepate, dextropropoxyphene, zopiclone moved between those profiles. The patterns of falsified prescriptions provided in this study contribute to enhance the scientific knowledge on the most diverted prescription drugs. The latter follow distinct trajectories across time depending on their pharmacology (including their abuse/addiction potential) and on their regulation's history. The close and continuous analysis of falsified prescriptions is an excellent way to monitor prescription drug diversion.
处方药的非法转移在质量和数量方面都很难评估。本研究旨在通过对2001年至2012年三个时期收集的伪造处方进行比较分析，来描述法国处方药的非法转移情况。对一个记录所有提交给社区药房的伪造处方的国家项目中记录的数据进行了研究。纳入的数据包括：受试者、处方形式和药物。通过聚类分析完成了对三个时期（2001 - 2004年、2005 - 2008年和2009 - 2012年）数据集的描述，以刻画与报告最多的药物相关的处方和受试者特征。4469份伪造处方中女性最为常见（51.6%）。平均年龄为46.5岁。唑吡坦、溴西泮和丁丙诺啡是最常涉及的药物。仅13种药物（1.7%，13/772）就占了总报告数（3055/7272）的40%以上。它们与三种非法转移模式相关：（i）年轻男性提交的重叠安全处方形式上提到了丁丙诺啡、氟硝西泮和吗啡；（ii）有经验的女性提交的简单处方形式上提到了阿普唑仑、溴西泮、唑吡坦、可待因/对乙酰氨基酚；（iii）老年受试者提交的修改处方形式上提到了对乙酰氨基酚和劳拉西泮。氯硝西泮、氯氮卓、右丙氧芬、佐匹克隆在这些模式之间变动。本研究中提供的伪造处方模式有助于增进对非法转移最多的处方药的科学认识。后者根据其药理学特性（包括其滥用/成瘾潜力）及其监管历史在不同时间遵循不同的轨迹。对伪造处方进行密切和持续的分析是监测处方药非法转移的绝佳方式。
