Nantes Université, CHU de Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000 Nantes, France.
Nantes Université, CHU de Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000 Nantes, France; Nantes Université, Université Tours, CHU Nantes, CHU Tours, Inserm, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, 44000 Nantes, France.
Therapie. 2024 Nov-Dec;79(6):623-633. doi: 10.1016/j.therap.2024.07.001. Epub 2024 Jul 11.
For several years, both the French Addictovigilance Network and French health authorities have consistently emphasized the need to provide opioid users with take-home naloxone (THN), the specific antidote for opioid overdoses. In March 2022, the French Health Authority recommended systematically assessing the appropriateness of prescribing THN to all opioid users, regardless of the context, and identified 8 high-risk situations. However, at present, THN distribution remains limited, particularly among primary care healthcare professionals. This study, conducted by the Pays de la Loire Centre for Evaluation and Information on Drug Dependence-Addictovigilance and supported by the Regional Health Agency, aims to explore healthcare professionals' practices and perceptions of these high-risk situations.
An ad-hoc questionnaire was distributed via mail by the project's regional institutional partners to the target healthcare professionals: pharmacists, general practitioners (GPs), physicians practicing in specialities other than general medicine (SPs: algologists, psychiatrists and addictologists). It was completed online from 20/10/2022 to 30/12/2022.
Out of the 355 participants (158 pharmacists, 167 GPs and 30 SPs), nearly all were managing patients on opioids. In total, 47.7% of physicians and 27.8% of pharmacists reported experiencing difficulties in dealing with the risk of overdose when prescribing or dispensing opioids to their patients. In the 12months preceding the study, only 8 pharmacists and 34 physicians had prescribed/dispensed THN, primarily due to a lack of awareness of its existence (52% of pharmacists and 72% of physicians) and challenges in addressing the eight overdose risk situations listed by the HAS (ranging from 54% to 83% for all professionals). The best-trained healthcare professionals were those who prescribed the most THN (P<0.001).
The identification of barriers related to THN distribution in the regional SINFONI study, conducted among primary care healthcare professionals managing patients on opioids, highlights the need to develop a training tool specifically tailored for these professionals.
多年来，法国药物警戒网络和法国卫生当局一直强调有必要向阿片类药物使用者提供纳洛酮（THN），这是阿片类药物过量的特效解毒剂。2022 年 3 月，法国卫生当局建议系统评估向所有阿片类药物使用者开具 THN 的适宜性，无论情况如何，并确定了 8 种高危情况。然而，目前，THN 的分发仍然有限，特别是在初级保健医疗保健专业人员中。这项由卢瓦尔河地区药物依赖评估和药物警戒中心开展的研究得到了地区卫生局的支持，旨在探讨医疗保健专业人员对这些高危情况的实践和看法。
该项目的地区机构合作伙伴通过邮件向目标医疗保健专业人员（药剂师、全科医生（GP）、非普通医学专科医生（SP：麻醉师、精神科医生和成瘾专家）分发了一份专门的问卷。从 2022 年 10 月 20 日至 12 月 30 日，参与者在线完成了问卷。
在 355 名参与者中（158 名药剂师、167 名全科医生和 30 名 SP），几乎所有人都在管理阿片类药物患者。总的来说，47.7%的医生和 27.8%的药剂师报告在为患者开具或分发阿片类药物时，在处理药物过量风险方面存在困难。在研究之前的 12 个月内，只有 8 名药剂师和 34 名医生开具/分发了 THN，主要是因为他们不知道其存在（52%的药剂师和 72%的医生），并且难以解决 HAS 列出的 8 种药物过量风险情况（所有专业人员的比例从 54%到 83%不等）。接受过最佳培训的医疗保健专业人员是那些开具 THN 最多的人（P<0.001）。
在卢瓦尔河地区 SINFONI 研究中，对管理阿片类药物患者的初级保健医疗保健专业人员进行调查后发现，THN 分发存在障碍，这突出表明需要为这些专业人员专门开发一种培训工具。
