A report provides an update on pain medications with effects comparable to opium. It details prescriptions but also misuse, and notes a growing number of deaths.

More and more French people are taking opioid painkillers, the effects of which are comparable to those of opium. In 2015, nearly ten million people received a prescription for one of these highly addictogenic drugs. On the podium of prescriptions is tramadol, followed by codeine and opium. In a report released Wednesday, the National Agency for Drug Safety (ANSM) for the first time a review of their consumption in France. A highly anticipated state of affairs at a time when these substances are causing an unprecedented health crisis in North America. Every day, 115 Americans die from an overdose of opioids.

More and more poisonings

"France is not in a situation comparable to that of the United States, immediately reassures the Pr Nicolas Authier, head of the department of medical pharmacology of the University Hospital of Clermont-Ferrand and director of the French Observatory of analgesic drugs. On the other hand, the rapid increase in the number of intoxications, hospitalizations and deaths shows that we must remain vigilant. "In ten years, the annual number of poisoning with opioid analgesics has doubled. A total of 2,762 accidents of this type were reported between 2005 and 2016. The number of hospitalizations has increased by 167% since 2000, with nearly 2,600 people in 2017. As for the number of deaths, it jumped 146% between 2000 and 2015. Now, four people die each week of an overdose of opioid painkiller. Among the drugs most involved, tramadol (37 deaths in 2016) followed by morphine (22 deaths), codeine (16 deaths) and oxycodone (8 deaths). "The damage is small compared to North America, says Pr Authier. But we must bear in mind that these figures underestimate the reality. "A view shared by Nathalie Richard, deputy director of drugs in neurology, analgesics and narcotics at the ANSM, who oversaw the report:" We don " we do not have exhaustive data, but what is interesting is to follow their evolution. "

Unlike other analgesics (paracetamol, aspirin …), opioids can be highly addictive. And an overdose can cause death by respiratory arrest. They are classified in two categories: weak opioids (tramadol, codeine, opium, for example) and strong opioids (morphine, oxycodone, fentanyl), which are narcotics. Whether they are weak or strong, they all expose to the same risks. "When these medications are taken chronically for several weeks, a physical dependency can set in," says Pr Authier. After developing a tolerance, the patient is forced to increase the doses to feel the same effects. "We see patients who can take up to 50 or 60 tablets a day, where it should not exceed 6 or 8 tablets," says the doctor.

Mostly women

What is the patient profile? According to the ANSM report, it is most often people suffering from acute pain, chronic pain, back pain or pain related to osteoarthritis. The average age is around 52 years for weak opioids and 64 years for strong opioids. The majority of patients are women. "Our patients systematically present vulnerability factors," notes Nicolas Authier. Anxiety disorders, mood, psychological trauma or a history of addiction make them misuse of these drugs: "They soon realize that the medicine does not only act on their pains, but also on their emotions. They are then looking for this anxiolytic effect. "

Those who fall into the trap of addiction, however, face a wall because it is not easy to get these drugs in France. Since July 2017 – date since the codeine is no longer over the counter – all opioid analgesics are available only on prescription. As for strong opioids, they are issued only on secure orders, traceable by a lot number and valid only 28 days. So to get their dose, the "addicts" are ready for anything: tour of medical offices and pharmacies, falsification of orders or order on the Internet. "One of my patients needed 18 tramadol tablets a day, so it should not be more than 4," says Pr Authier. After years of medical and pharmaceutical nomadism, he ended up getting boxes of 100 tablets on the Internet. "

"This report shows that pain is better managed in France, but this improvement is accompanied by a number of problems that must be monitored," concludes Nathalie Richard. From now on, the focus should be on identifying patients at risk as well as informing health professionals. Many doctors do not know that tramadol is an opioid. "

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