• Drug Alcohol Depend · May 2016

    Incidence of high dosage buprenorphine and methadone shopping behavior in a retrospective cohort of opioid-maintained patients in France.

    • Jessica Delorme, Chouki Chenaf, Jean-Luc Kabore, Bruno Pereira, Aurélien Mulliez, Aurore Tremey, Georges Brousse, Marie Zenut, Catherine Laporte, and Nicolas Authier.
    • INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, BP38, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, BP69, 63003 Clermont-Ferrand, France. Electronic address: jdelorme@chu-clermontferrand.fr.
    • Drug Alcohol Depend. 2016 May 1; 162: 99-106.

    BackgroundOpioid Substitution Treatment (OST) misuse and diversion have significantly increased worldwide. Obtaining OST prescriptions from multiple prescribers, known as doctor shopping, is a way in which opioids may be diverted.ObjectivesThe aim of this study was to assess the incidence of OST (high dosage buprenorphine (HDB) and methadone (MTD)) shopping behavior and identify associated risk factors, and its impact on mortality.MethodsA retrospective cohort of patients treated by OST between April 1, 2004 and December 31, 2012 from a sample of the French Health Insurance database was established. Doctor shopping was defined as ≥1 day of overlapping prescriptions written by ≥2 different prescribers and filled in ≥3 different pharmacies.ResultsA total of 2043 patients were enrolled, 1450HDB and 593 MTD. The one-year incidence of shopping behavior was 8.4% (95% CI: 7.0-10.1) in HDB group and 0% in MTD group, compared to 0.2% (95% CI: 0.1-0.2) for diuretics. On multivariate analysis, factors associated with HDB shopping behavior were: male gender HR: 1.74 (95% CI: 1.20-2.54); low-income status HR: 2.95 (95% CI: 2.07-4.44); mental health disorders HR: 1.43 (95% CI: 1.06-1.94); concurrent hypnotics use HR: 1.90 (95% CI: 1.39-2.61); concurrent use of weak opioids HR: 1.48 (95% CI: 1.09-1.99) and morphine HR: 1.69 (95% CI: 1.02-2.80). HDB shoppers had a higher, yet non-significant risk of death (HR: 1.56 (95% CI: 0.64-3.81)) than non HDB shoppers.ConclusionShopping behavior was only found in high dosage buprenorphine patients and concerned almost one out ten patients.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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