Nantes Université, CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000, Nantes, France.
Nantes Université, Univ Tours, CHU Nantes, CHU Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, 44000, Nantes, France.
Harm Reduct J. 2024 Jan 23;21(1):20. doi: 10.1186/s12954-024-00941-y.
Opioid-related mortality is a rising public health concern in France, where opioids were in 2021 implicated in 75% of overdose deaths. Opioid substitution treatment (OST) was implicated in almost half of deaths related to substance and drug abuse. Although naloxone could prevent 80% of these deaths, there are a number of barriers to the distribution of take-home naloxone (THN) among opioid users in France. This study is the first one which compares patients' self-assessment of the risk of future opioid overdose with the hetero-assessment provided by healthcare professionals in a population of individuals eligible for naloxone.
This was a multicenter descriptive observational study carried out in pharmacies across the Pays de la Loire region (France) during April and May 2022. All adult patients who visited a participating pharmacy for a prescription of OST and provided oral informed consent were enrolled in the study. Retrospective data were collected through cross-sectional interviews conducted by the pharmacist with the patient, utilizing an ad hoc questionnaire. The patient's self-assessment of overdose risk was evaluated using a Likert scale from 0 to 10. The pharmacist relied on the presence or absence of overdose risk situations defined by the French Health Authority (HAS). The need to hold THN was assessed using a composite criterion.
A total of 34 patients were interviewed; near one third were aware of the existence of THN and a minority had THN in their possession. Out of the 34 participants, 29 assessed their own risk of future opioid overdose: 65.5% reported having zero risk, while 6.9% believed they had a high risk. Nevertheless, at least one risk situation of opioid overdose was identified according to HAS criteria in 73.5% of the participants (n = 25). Consequently, 55% of the participants underestimated their risk of experiencing a future opioid overdose. Yet, dispensing THN has been judged necessary for 88.2% of the participants.
This study underscored the imperative need to inform not only healthcare professionals but also the patients and users themselves on the availability of THN and the risk situations of opioid overdose.
在法国，阿片类药物相关死亡率是一个日益严重的公共卫生问题，2021 年阿片类药物与 75%的过量死亡有关。阿片类药物替代疗法（OST）与近一半与物质和药物滥用相关的死亡有关。尽管纳洛酮可以预防 80%的这些死亡，但在法国，阿片类药物使用者中分发携带纳洛酮（THN）存在许多障碍。这项研究是首次在有资格接受纳洛酮的人群中，比较患者对未来阿片类药物过量风险的自我评估与医疗保健专业人员提供的异质评估。
这是一项多中心描述性观察研究，于 2022 年 4 月至 5 月在法国卢瓦尔河地区的药店进行。所有到参与药房就诊开 OST 处方并提供口头知情同意的成年患者均被纳入研究。通过药剂师与患者进行的横断面访谈，利用专门的问卷收集回顾性数据。患者对过量风险的自我评估采用 0 到 10 的李克特量表进行评估。药剂师根据法国卫生署（HAS）定义的过量风险情况的存在或不存在进行评估。THN 的需求使用综合标准进行评估。
共采访了 34 名患者；近三分之一的人知道 THN 的存在，少数人拥有 THN。在 34 名参与者中，有 29 名评估了自己未来阿片类药物过量的风险：65.5%的人报告没有风险，而 6.9%的人认为他们有很高的风险。然而，根据 HAS 标准，参与者中有 73.5%（n=25）至少存在一种阿片类药物过量的风险情况。因此，55%的参与者低估了他们未来阿片类药物过量的风险。然而，88.2%的参与者认为分发 THN 是必要的。
这项研究强调了不仅要告知医疗保健专业人员，还要告知患者和使用者自己 THN 的可用性和阿片类药物过量的风险情况的迫切需要。
