Use And Misuse Of Opioid Replacement Therapy In France

1342 words - 5 pages

DISCUSSION
A cohort from French National Healthcare Insurance Database named EGB allowed identifying patients with health care consumption related to ORT in 2006–2012. There are some limitations in the use of this medico-administrative cohort. Some categories such as students and civil servants benefit of specific healthcare insurances and are not included in the EGB cohort. Drug users are frequently in precarious situation and are automatically affiliated to a free complementary Universal Health Insurance (“CMU”) for delivery of ORT; therefore, they are probably overrepresented in EGB. In contrast with HDB that is most frequently delivered in retail pharmacies, early treatment with methadone is frequently directly obtained in hospital pharmacies or in centers specialized in the treatment of drug abuse. These deliveries are not reported in EGB. Our results provide nevertheless an overview of the delivery of methadone through retail pharmacies. There are also limits related to the real consumption of patients. For example, a patient who seems to receive high doses of ORT may sell a part of the reimbursed drugs; conversely, some patients may obtain ORT from the illicit market.
According to our results, the population treated with ORT steadily increased: from 1014 patients in the cohort in 2006 to 1211 patients in 2012. Male gender was predominant (three men for one woman) and mean age was 34 years at initiation of ORT. HDB remained predominant among reimbursed ORT; however, the part of methadone steadily increases from 20% in 2006 to 32.5% in 2012. These results on patient characteristics and evolution of methadone use confirm recent published data [1, 12, 13].
One of the objectives of the study was to evaluate the risk of misuse through some warning criteria such as high daily dose or medical nomadism. The mean daily dose of HDB in the study cohort varied from 8.2 mg in 2006 to 8.9 mg in 2011. The rates of patients treated with a mean daily dose > 16 mg (considered as a misuse) and > 32 mg were 13.3% and 1.3% in 2011, respectively. These results fitted with the data from the report of OFDT (“French Monitoring Centre for Drugs and Drug Addiction”) for year 2007: the mean daily dose in HDB population was estimated at 8.9 mg/day; 13.0% of patients had a daily mean dose above 16 mg/day and 1.6% above 32 mg/day.
For methadone, the mean daily dose varied from 41.8 mg in 2006 to 46.7 mg in 2011. This dose remains however below the recommended dose, which is between 60 and 100 mg. It has been suggested that the reason of these low doses was related to the progressive extension of ORT to younger patients probably less dependant [13]. The rates of patients treated with a mean daily dose > 16 mg were 3.0% in 2006 and 5.6% in 2011. In the report of OFDT, similar results were obtained for 2001: 6.0% of patients treated with methadone had mean daily dose above 100 mg.
For HDB, we observed that patients associated with ≥ 5 different prescribing physicians...

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