Frauger Elisabeth, Kheloufi Farid, Boucherie Quentin, Monzon Emilie, Jupin Leonard, Richard Nathalie, Mallaret Michel, Micallef Joëlle
CEIP-addictovigilance, service de pharmacologie clinique et pharmacovigilance, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France; Aix-Marseille université, institut de neurosciences des systèmes, Inserm UMR1106, 13005 Marseille, France.
Aix-Marseille université, institut de neurosciences des systèmes, Inserm UMR1106, 13005 Marseille, France; Centre régional de pharmacovigilance, service de pharmacologie clinique et pharmacovigilance, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, 13009 Marseille, France.
Therapie. 2018 Dec;73(6):511-520. doi: 10.1016/j.therap.2018.07.001. Epub 2018 Jul 7.
Over the course of these last decades, we observed a change on opioid use with the marketing of opiate maintenance treatment, an increase of opioids used for pain management and recent concerns have arisen around the use of synthetic opioid. The World Health Organization (WHO) reports around 70,000 people opioid overdose death each year. In France, according to the DRAMES program (fatalities in relation with abuse of licit or illicit drugs) of the French addictovigilance network, most of deaths are related to opioids overdose (especially methadone, following by heroin, buprenorphine and opioid used for pain management). Opioid overdose is treatable with naloxone, an opioid antagonist which rapidly reverses the effects of opioids. In recent years, a number of programs around the world have shown that it is feasible to provide naloxone to people likely to witness an opioid overdose. In 2014, the WHO published recommendations for this provision and the need to train users and their entourage in the management of opioid overdose. In this context, in July 2016, French drug agency has granted a temporary authorization for use of a naloxone nasal spray Nalscue. Because different opioids can be used and because each opioid has specific characteristics (pharmacodynamics, pharmacokinetics, galenic form…), the risk of overdose may differ from one opioid to another and it may be necessary, depending on the clinical context, to use larger and repeated doses of naloxone.
在过去几十年间，我们注意到随着阿片类药物维持治疗的推广，阿片类药物的使用发生了变化，用于疼痛管理的阿片类药物有所增加，最近人们对合成阿片类药物的使用也产生了担忧。世界卫生组织（WHO）报告称，每年约有7万人死于阿片类药物过量。在法国，根据法国药物警戒网络的DRAMES项目（与合法或非法药物滥用相关的死亡情况），大多数死亡与阿片类药物过量有关（尤其是美沙酮，其次是海洛因、丁丙诺啡和用于疼痛管理的阿片类药物）。阿片类药物过量可用纳洛酮治疗，纳洛酮是一种阿片类拮抗剂，能迅速逆转阿片类药物的作用。近年来，世界各地的一些项目表明，向可能目睹阿片类药物过量情况的人提供纳洛酮是可行的。2014年，WHO发布了关于提供纳洛酮以及培训使用者及其随行人员管理阿片类药物过量的建议。在此背景下，2016年7月，法国药品管理机构批准了纳洛酮鼻喷雾剂Nalscue的临时使用许可。由于可以使用不同的阿片类药物，且每种阿片类药物都有特定的特性（药效学、药代动力学、剂型……），不同阿片类药物的过量风险可能不同，根据临床情况，可能需要使用更大剂量且重复使用纳洛酮。
