• Camille Ponté, Marion Lepelley, Quentin Boucherie, Michel Mallaret, Lapeyre Mestre Maryse M Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CIC 1436, UMR 1027 , Vincent Pradel, and Joëlle Micallef.
• Centre d'Evaluation et d'Information de la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CIC 1436, UMR 1027 Inserm-Université Paul Sabatier Toulouse III, France.
• Drug Alcohol Depend. 2018 Jun 1; 187: 88-94.

BackgroundThe abuse of prescription opioids and its subsequent consequences is an important public concern particularly in the USA. The literature on opioid analgesic abuse is scarce.ObjectiveWe assess the extent and risk of opioid analgesics abuse relative to benzodiazepines (BZD) using the doctor shopping method, taken into account the pharmacological characteristics (dosage, route of administration, extended or immediate release).MethodsWe used SNIIRAM database covering 11.7 million inhabitants. All individuals with at least one reimbursement for non-injectable opioid analgesic or BZD in 2013 were included. Opioids for mild to moderate pain and for moderately severe to severe pain were studied. The Doctor Shopping Quantity (DSQ) is the quantity obtained by overlapping prescriptions from several prescribers. The Doctor Shopping Indicator (DSI) is the DSQ divided by the total dispensed quantity.ResultsThe strong opioid analgesics have the highest DSI (2.79%) versus 2.06% for BZD hypnotics. Flunitrazepam ranked first according to its DSI (13.2%), followed by morphine (4%), and zolpidem (2.2%). The three-strong opioids having the highest DSI were morphine, oxycodone and fentanyl (respectively 4%, 1.7% and 1.5%). The highest DSI was observed for the highest dosages of morphine (DSI = 8.4% for 200 mg) and oxycodone (DSI = 2.8% for 80 mg). The highest DSI for fentanyl was described with nasal and transmucosal forms (4.1% and 3.3% respectively). The highest DSI for morphine was described for extended-release (4.1%).ConclusionThere is a need to reinforce surveillance systems to track opioid misuse and to increase awareness of healthcare professionals.Copyright © 2018 Elsevier B.V. All rights reserved.

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