BACKGROUND:Cocaine use disorder (CUD) remains a major public health concern, characterized by high relapse rates and the absence of approved pharmacological treatments. Glucagon-like peptide-1 receptor agonists (GLP-1RA), widely prescribed for metabolic disorders, modulate mesolimbic reward pathways and have been proposed as potential modulators of addictive behaviors. OBJECTIVES:To describe clinical observations of GLP-1RA exposure in individuals with CUD identified through the French national vigilance system and to contextualize these findings through a structured narrative review of preclinical and clinical evidence. METHODS:Cases involving GLP-1RA exposure in individuals with ongoing cocaine use were identified through the French national vigilance system and described. A structured literature search (MEDLINE, Embase, Google Scholar) identified original preclinical and clinical studies examining the effects of GLP-1 receptor activation on cocaine-related behavioral and neurobiological outcomes. RESULTS:Two cases involving patient-initiated off-label GLP-1RA use motivated by perceived anti-craving effects were identified through the vigilance system. The literature synthesis included 22 original publications (17 preclinical and 5 human studies). Across experimental models, GLP-1 receptor activation reduced cocaine self-administration, conditioned reward, and relapse-like behaviors. These effects were associated with the attenuation of mesolimbic dopamine signaling, including reduced cocaine-evoked dopamine release and modulation of dopamine transporter function. Human evidence remains limited and heterogeneous. CONCLUSION:GLP-1 receptor signaling represents a biologically plausible target in CUD. However, current clinical evidence remains preliminary. Patient-driven observations underscore the need for controlled clinical trials and continued vigilance monitoring.

Opioid-related mortality is a global issue, and France shows high opioid use disorder indicators. Despite recommendations for wider take-home-naloxone distribution, access remains limited in France, and many primary care professionals lack training. The SINFONI project aims to enhance naloxone education for these providers. A motion-design training program was created and sent to general practitioners (GPs) and pharmacists. A total of 138 GPs and 207 pharmacists participated in the knowledge assessment before and after training. Post-training, significant improvements were observed, and the greatest knowledge gains were in understanding naloxone's safety (P < .001). Our findings primarily identified critical "red flags" that may hinder prescription and dispensing practices.

Objectifs Comparer les performances et l’intérêt clinique de la spectrométrie de masse haute résolution (LC-HR/MS) et d’une méthode d’immuno-analyse pour le dépistage urinaire des substances psychoactives (SPA) chez les patients hospitalisés en addictologie. Méthodes Un prélèvement urinaire était réalisé en début d’hospitalisation et analysé par méthode immuno-analyse (c503 CobasPro®, Roche Diagnostic®) et LC-HR/MS (Orbitrap exploris 120, Thermofisher®). Chaque SPA déclarée, ainsi que les médicaments prescrits ou non, étaient comparés aux résultats des analyses et les éventuelles discordances entre les deux méthodes d’analyses ainsi que la détection de substances non déclarées ont été étudiées afin d’évaluer la pertinence analytique de la LC-HR/MS. Une performance supérieure de celle-ci était définie soit par une nouvelle détection d’une substance non détectée ou non recherchée en immuno-analyse, la correction d’une erreur d’identification de l’immuno-analyse, la non détection d’une substance recherchée ou non en immuno-analyse pour laquelle une limite d’identification en LC-HR/MS était renseignée. La pertinence clinique des résultats obtenus avec la méthode en LC-HR/MS par rapport à ceux de l’immuno-analyse a été évaluée avec les cliniciens du service d’addictologie lors de réunions trimestrielles une fois le patient sorti d’hospitalisation et le dossier anonymisé. Résultats Dans cette étude observationnelle monocentrique prospective, 154 patients hospitalisés pour des troubles addictifs liés à un usage de SPA ont été inclus. Le prélèvement urinaire a été réalisé en moyenne 1,6jours±1 jour après le début d’hospitalisation. Concernant les molécules « hors prescription » (substances illicites et médicaments mésusés), la LC-HR/MS a montré une performance supérieure pour plus de la moitié des substances déclarées par le patient. Elle a essentiellement permis de détecter parmi ces molécules « hors prescription », des substances non recherchées en immuno-analyse et/ou non déclarées, notamment des analgésiques, des antidépresseurs, ainsi que des anti-histaminiques. De surcroît, la LC-HR/MS a permis de détecter une substance qui n’avait pas été détectée par l’immuno-analyse (principalement cocaïne et méthadone) pour plus d’une consommation déclarée sur dix. La LC-HR/MS a également montré une performance supérieure dans la détection de médicaments prescrits pour 71 % des cas qui concernaient, pour quasiment la totalité de ces cas, des substances non recherchées en immuno-analyse. Concernant l’impact clinique, les résultats obtenus par LC-HR/MS ont été jugés utiles par les cliniciens et auraient modifié la prise en charge pour un quart des patients. Dans la plupart des cas il s’agissait de molécules détectées et non déclarées par le patient. De plus, la LC-HR/MS a également permis de corriger un résultat d’amphétamine rendu faussement positif. Conclusion La comparaison de ces deux méthodes met en évidence un bénéfice analytique et clinique de la LC-HR/MS par rapport à l’immuno-analyse dans le dépistage urinaire des SPA tirant parti d’une meilleure sensibilité et d’un panel plus large de SPA recherchées. Si pour certains patients, la valeur ajoutée de la LC-HR/MS reste limitée, en cas de consommations complexes, de mésusage ou de prise de SPA non prescrites ou cachée, la méthode en LC-HR/MS permet un état des lieux plus complet et d’influencer la prise en charge du patient. Un point de vigilance particulier concerne le fait qu’il est particulièrement nécessaire de recueillir, dès l’admission, le prélèvement urinaire afin d’optimiser la détection des substances psychoactives à demi-vie courte et de tirer parti au maximum de cette approche. Ces résultats confirment l’intérêt de la LC-HR/MS dans le dépistage urinaire des SPA chez les patients hospitalisés en addictologie. Certains profils de patients doivent être particulièrement ciblés pour orienter la prise en charge clinique.

Background: In France, the increasing use of nonmedical nitrous oxide (N2O) among young consumers has become a concern. Faced with this increase in consumption, authorities have set up information campaigns and have taken regulatory measures to limit this phenomenon. The addictovigilance network is the French health monitoring system dedicated to the surveillance of psychoactive substances coordinated by the French National Agency for the safety of Medicines and Health Products (ANSM). We describe and discuss the evolution of notifications to the French addictovigilance network for N2O in the context of policy changes aiming to limit nonmedical use. Methods: The monthly number of N2O notifications and clinical complications of N2O reported to French addictovigilance centres, between 2018 and 2022, were analyzed. In parallel, information from health authorities (i.e ANSM, French National Agency for Food, Environmental and Occupational Health Safety and French Ministry of health) and regulatory changes were described. Results: The number of addictovigilance notifications increased almost 35-fold between 2018 (n=10) and 2022 (n=345), which corresponds to a slope coefficient of 0.6448 (R2) dependent on complication type: use disorders or associated criteria (+4257%, R2= 0.6366), neurological complications (+4883%, R2=0.6397), psychiatric manifestations (+650%, R2=0.2847) and cardiovascular complications (+867%, R2=0.3061). Between November 2019 and 2022, four information alerts about serious health consequences (in the form of 2 press releases and information on the health authority website) were issued by French health authorities, and a law prohibiting sales to minors (i.e. under 18 years old) and to prohibit sales in high risk locations (for example bars, tobacco shops, student parties) was introduced in France in June 2021. Conclusion: Despite the various measures taken, there has been no decrease in the number of notifications and complications reported to the French addictovigilance network. The pattern of increasing notifications is in line with global trends.

AIMS:We sought to characterize adverse events and deaths associated with the use of psychoactive substances in children and adolescents. METHODS:Two French Addictovigilance databases were analysed: spontaneous reports and deaths over the period 2016-2021, in subjects aged 10-<18 years. An unsupervised classification was implemented on consumption data (medications or nondrug substances [NDS]) to identify subject clusters. RESULTS:A total of 1544 spontaneous reports were analysed, comprising mainly boys (65.6%), aged on average 16 ± 1 years. Four clusters were identified: The cannabinoids users cluster (n = 597) was typified by the use of cannabis or/and synthetic cannabinoids (95.1%), with psychiatric (67.7%) and digestive disorders (16.7%). The medications/solvents/cannabidiol users cluster (n = 699) was distinguished by the use of medications or NDS including nitrous oxide/cannabidiol, with mainly neurological disorders (46.5%). The polydrug users cluster (n = 177) includes polyusers (98.3%) of NDS and medications. These users mainly have substance use disorders (63.8%). The psychotropic medications users cluster (n = 71) was characterized by the use of psychotropic medications. This cluster appeared to be correlated with psychiatric and organic disorders. The death database recorded 44 deaths, mainly in boys (61.4%) aged over 15 years. The main substances involved in the deaths were NDS (70.5%) and methadone. In 68.2% of cases, a single substance was responsible for the death. CONCLUSION:The adverse events related to the abuse of psychoactive substances identified in children and adolescents and the emerging signals show the need for increased surveillance and the implementation of prevention campaigns adapted to each group of consumers.

Introduction: Immunoassay (IA) is currently used at Nantes University Hospital to perform urine drug screening in the inpatient addiction unit. Given its numerous limitations, we aimed to assess the overall benefit of the Liquid-Chromatography-High-Resolution-Mass Spectrometry (LC-HRMS), and to identify the profiles of patients for whom its use provided a clinical benefit. Methods: All adult patients admitted to this unit between January and September 2023 were systematically included. A part of the urine sample routinely collected on admission was retained for subsequent analysis by LC-HRMS. For each active molecule, the analytical performance of LC-HRMS compared with IA was evaluated by biologists. Then unit's physicians assessed for each patient whether the new data provided by LC-HRMS would have had an impact on their management. A multivariate analysis was carried out to identify the profiles of these patients. Results: 154 patients were included with 293 non-prescribed molecules and 434 prescribed drugs. For 2/3 of all molecules, LC-HRMS performed better than IA. Most of these molecules were not detectable by IA but some were not detected even though they belonged to the panel of detectable substances. Physicians considered that the new results provided by LC-HRMS would have had an impact on the management of 1/4 of patients. A history of opiate abuse/dependence was associated with a clinical benefit of LC-HRMS in the multivariate analysis. Conclusion: These results confirm the benefit of LC-HRMS for urine drug screening in inpatient addiction units for patients with multiple substance use, especially those with a history of opioid use.

Le chemsex se définit classiquement par l’usage de substances psychoactives avant ou pendant les relations sexuelles afin d’améliorer performance, durée et plaisir sexuel. Cette pratique peut avoir des conséquences sanitaires individuelles très importantes (complications addictologiques, somatiques) et populationnelle (transmission d’infections virales ou bactériennes). Le chemsex a émergé en France à partir de 2009, avec l’apparition des nouveaux produits de synthèse (NPS) et d’internet (achat des produit et site de rencontre). La population principalement concernée par le chemsex est la population des hommes ayant des rapports sexuels avec des hommes (HSH). L’addictoVigilance est un acteur de veille sanitaire incontournable de la surveillance des complications en lien avec la pratique du chemsex et ce à travers des indicateurs clairs : complications médico-légales (évolution des décès via l’enquête annuelle DRAMES et des soumissions chimiques), des évènements graves (troubles addicto-psychiatriques, neurologiques, cardiovasculaires, infectieux) via les notifications spontanées. Une mise à jour des données d’addictovigilance proposée dans cet article montre une augmentation importante et inquiétante des complications et des décès en lien avec cette pratique depuis 2008 (nombre de cas multiplié par un facteur 3 en 5 ans). La persistance à bas bruit de la pratique du chemsex par voie injectable est retrouvée dans les données avec des complications infectieuses pouvant se compliquer en arthrite septique. Les antécédents infectieux sont en baisse dans la population des chemsexeurs, que ce soit concernant le VIH, le VHC ou bien les autres IST. Les classes de substance rapportées sont toujours des cathinones de synthèse associées ou non à la cocaïne et au GHB/GBL. Les cathinones évoluent avec l’arrivée des dérivées chlorés type 3-CMC /4-CMC. Les principales complications sont les troubles liés à l’usage de substances, les infections (majoritairement abcès, hypodermite, nécroses), des troubles neurologiques impliquant dans la grande majorité des cas de G-holes (surdosage en lien avec le GHB/GBL), des troubles psychiatriques (psychoses avec hallucinations, délire, angoisse et dépression) et des complications cardiovasculaires en lien avec la toxicité des produits. Les agressions sexuelles et les cas de soumissions chimiques possibles soulignent les risques d’abus sexuels ou de rapports sexuels non-consentis plus importants dans le cadre du chemsex. La mise en place d’interventions multidisciplinaires a permis, pas à pas, une prise en charge holistique des chemsexeurs (addicto-psycho-socio-sexologique). La PrEP et la réduction des risques en matière de sexualité et de consommation de produits psychoactifs sont inscrites dans cette prise en charge. La diminution des antécédents infectieux est à souligner. Les initiatives de toutes parts, professionnels de santé ou société civile doivent continuer pour faire face à ce phénomène.

OBJECTIVE: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. METHODS: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. RESULTS: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). CONCLUSION: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.

Abstract Background In many countries, nitrous oxide is used in a gas mixture (EMONO) for short-term analgesia. Cases of addiction, with significant misuse, have been reported in hospitalized patients. Patients suffering from sickle cell disease (SCD) could represent a high-risk population for substance use disorder (SUD) due to their significant pain crisis and repeated use of EMONO. The objective of the PHEDRE study was to assess the prevalence of SUD for EMONO in French SCD patients. Results A total of 993 patients were included. Among 339 EMONO consumers, only 38 (11%) had a SUD, with very few criteria, corresponding mainly to a mild SUD due to a use higher than expected (in quantity or duration) and relational tensions with the care teams. Almost all patients (99.7%) were looking for an analgesic effect, but 68% of patients were also looking for other effects. The independent risks factors associated with at least one SUD criterion were: the feeling of effects different from the expected therapeutic effects of EMONO, at least one hospitalization for vaso occlusive crisis in the past 12 months and the presence of a SUD for at least one other analgesic drug. Conclusions The use of EMONO was not problematic for the majority of patients. Manifestations of SUD that led to tensions with healthcare teams should alert and lead to an evaluation, to distinguish a true addiction from a pseudoaddiction which may be linked to an insufficient analgesic treatment related to an underestimation of pain in SCD patients. Trial registration: Clinical Trials, NCT02580565. Registered 16 October 2015, https://clinicaltrials.gov/

The COVID-19 pandemic has had a substantial impact on mental health. An increase in the use of anxiolytic, hypnotic, and antidepressant drugs has been highlighted in France, but with no information at the individual level (trajectories) or concerning patient characteristics. The objective of this study was to describe the profile of new psychotropic drug users since the beginning of the pandemic. We formed two historical cohorts using the Pays-de-la-Loire regional component of the National Health Data System (SNDS): a "COVID-19 crisis cohort" (2020-2021) and a "control cohort" (2018-2019). We analyzed reimbursements for psychotropic medications (anxiolytics, antidepressants, hypnotics, mood stabilizers, and antipsychotics) using a multichannel sequence analysis and performed clustering analysis of sequences. The proportion of new consumers of psychotropic drugs was higher in the COVID-19 crisis cohort (18.0%) than that in the control cohort (16.0%). In the COVID-19 cohort, three clusters of psychotropic drug users were identified, whereas four clusters were identified in the control cohort. A time lag in treatment initiation was observed in the COVID-19 crisis cohort (September) compared with the control cohort (July). This study is one of the first to analyze the profile of psychotropic treatment users during the COVID-19 crisis. Our analysis sheds light on changes in patterns of psychotropic drug use during the COVID-19 pandemic, possibly associated with changes in prescribing conditions and mental health conditions during the crisis. This study also provides an example of the application of an innovative longitudinal analysis methodology in the field of pharmacoepidemiology.

Background Opioid-related mortality is a rising public health concern in France, where opioids were in 2021 implicated in 75% of overdose deaths. Opioid substitution treatment (OST) was implicated in almost half of deaths related to substance and drug abuse. Although naloxone could prevent 80% of these deaths, there are a number of barriers to the distribution of take-home naloxone (THN) among opioid users in France. This study is the first one which compares patients' self-assessment of the risk of future opioid overdose with the hetero-assessment provided by healthcare professionals in a population of individuals eligible for naloxone. Methods This was a multicenter descriptive observational study carried out in pharmacies across the Pays de la Loire region (France) during April and May 2022. All adult patients who visited a participating pharmacy for a prescription of OST and provided oral informed consent were enrolled in the study. Retrospective data were collected through cross-sectional interviews conducted by the pharmacist with the patient, utilizing an ad hoc questionnaire. The patient’s self-assessment of overdose risk was evaluated using a Likert scale from 0 to 10. The pharmacist relied on the presence or absence of overdose risk situations defined by the French Health Authority (HAS). The need to hold THN was assessed using a composite criterion. Results A total of 34 patients were interviewed; near one third were aware of the existence of THN and a minority had THN in their possession. Out of the 34 participants, 29 assessed their own risk of future opioid overdose: 65.5% reported having zero risk, while 6.9% believed they had a high risk. Nevertheless, at least one risk situation of opioid overdose was identified according to HAS criteria in 73.5% of the participants ( n = 25). Consequently, 55% of the participants underestimated their risk of experiencing a future opioid overdose. Yet, dispensing THN has been judged necessary for 88.2% of the participants. Conclusion This study underscored the imperative need to inform not only healthcare professionals but also the patients and users themselves on the availability of THN and the risk situations of opioid overdose.

Introduction L’étude SUSPENS évalue le bénéfice global de la mise en place d’une méthode de screening urinaire par LC-HRMS pour les patients hospitalisés en addictologie au CHU de Nantes, plus sensible et plus spécifique que la méthode d’immunohistochimie (IH) actuellement utilisée dans le cadre du soin. Dans ce travail, nous présentons une analyse des cas où les résultats du screening urinaire (LC-HRMS) ne correspondaient pas aux déclarations des patients. Matériel et méthodes Pour tous les patients majeurs hospitalisés dans le service d’addictologie du CHU de Nantes entre janvier et septembre 2023, les déclarations de consommation de médicaments (MED) et de substances non médicamenteuses (SNM) dans les 2 semaines précédant l’admission ont été recueillies auprès des patients lors de leur entretien d’accueil, en parallèle du prélèvement urinaire réalise à l’admission. Résultats Parmi les 154 patients inclus dans l’étude SUSPENS, 67,5 % (n=104) ont présenté une discordance entre leurs déclarations et le résultat de leur screening. (i) Une substance non déclarée a été détectée chez 86 patients. Parmi les molécules ont été retrouvées 21 SNM, majoritairement cocaïne (n=14) et cannabis (n=6), et 112 MED, majoritairement antidépresseurs (n=15), antihistaminiques (n=14) et antipsychotiques (n=10). Par ailleurs, du lévamisole a été identifié dans 1/3 des cas (n=24). (ii) Une substance déclarée n’a pas été détectée chez 41 patients. Parmi les molécules ont été retrouvées 19 SNM (majoritairement cannabis, n=10) sans qu’aucune autre substance non déclarée n’ait été détectée, et 23 MED prescrits (dont 3 antidépresseurs et 2 addictolytiques). Conclusion La mise en place d’une méthode de screening urinaire par LC-HRMS pour ces patients présente de multiples intérêts. En cas de détection de substances non déclarées par le patient, elle permet d’investiguer la persistance de consommation de médicaments prescrits qui auraient dû être arrêtés, un potentiel trouble de l’usage ou mésusage, que ce soit pour des SNM ou des MED comme les antihistaminiques, de potentielles « arnaques », et soulever des risques d’interactions médicamenteuses. L’identification de produits de coupe pharmacologiquement actifs fournit des éléments pour engager une discussion sur la réduction des risques et des dommages. La non-détection de substances déclarées révèle de probables « arnaques » ou une mauvaise observance de molécules d’intérêt. Enfin, cette méthode peut présenter un apport en termes de surveillance épidémiologique des substances. Bien qu’aucun NPS n’ait été détecté dans cette étude, la LC-HRMS permet leur détection, et l’implémentation systématique de cette méthode pourrait constituer un observatoire des substances complémentaire du dispositif SINTES.

BackgroundDue to its psychoactive effects, ketamine has become a drug used for non-medical purpose.ObjectivesTo assess the latest trends in ketamine use among people with substance use disorder and to characterize its clinical complications using complementary health data sources of the French Addictovigilance Network.MethodsFirst, we extracted all reports involving ketamine from 2012 to 2021 from the database of the OPPIDUM program (i.e., a multicentric program conducted in collaboration with hundreds of substance abuse treatment facilities that collects data on drugs used by subjects with substance use disorders). We described the reports globally and the changes from 2012 to 2021. Second, we extracted all cases involving ketamine from July 2020 to December 2022 from the French National Pharmacovigilance Database (BNPV). We identified the cases related to ketamine use among people with substance use disorder and described them.ResultsThere was a 2.5-fold increase in the number of ketamine users with substance use disorder in the OPPIDUM program, from 35 (0.7%) subjects in 2012 to 89 (1.7%) subjects in 2021. There was an increase in the proportion of subjects who were daily users, had distress upon discontinuation, and presented addiction. There were 238 cases related to ketamine use among people with substance use disorder in the French National Pharmacovigilance Database from July 2020 to December 2022. Among them, 94 (39.5%) cases involved ketamine use disorder, 20 (8.4%) cases involved urinary tract and kidney symptoms, and 13 (5.5%) cases involved hepatobiliary symptoms.ConclusionThe trend observed over 10 years reflects the growth in ketamine use among people with substance use disorder, although it does not allow to estimate the rates of non-medical use of ketamine in the general population. Ketamine-induced uropathy and cholangiopathy are reported in ketamine users with substance use disorder, especially in case of repeated and/or prolonged use of high doses.

Due to the risk of overdoses increase especially with methadone, a reinforced monitoring has been set up by the French Addictovigilance Network following the first lockdown related to coronavirus disease 2019 (COVID-19). In this context, we managed a specific study to analyze overdoses related to methadone in 2020 compared to 2019.

Caractériser les risques associés à l'usage de substances psychoactives chez les mineurs via l'analyse des données du réseau français des centres d'addictovigilance (FAN). Les données issues des notifications spontanées (NotS) recueillies par le FAN entre 2016 et 2021 chez les mineurs de plus de 10 ans ont été analysées. Une classification non supervisée a été implémentée sur les données de consommation (substances médicamenteuses [SM] ou non médicamenteuses [SNM]), afin d'identifier des profils de sujets. Les caractéristiques sociodémographiques et les complications ont été comparées entre ces différents groupes. Un total de 1544 NotS a été analysé, majoritairement des garçons (65,6 %), âgés en moyenne de 16 ± 1 ans. Une polyconsommation est rapportée pour 13 % d'entre eux. La classification a mis en évidence 4 groupes : – groupe 1 (n = 629), caractérisé par l'usage de cannabis (89,8 %) associé ou non à d'autres SNM (hallucinogènes et stimulants) et par des complications psychiatriques (symptômes psychotiques 14,3 %, maniaques 12,4 %, troubles du comportement 18,4 %, de l'humeur 14,2 %, comportement suicidaire 7,3 %) et des troubles digestifs (16,2 %) ; – groupe 2 (n = 660) se distingue par des jeunes, non-consommateurs de cannabis (5 %), mais usagers de SM (benzodiazépines 20 %, gabapentinoides 13,9 %, d'opioïdes 20 % [codéine/tramadol]) ou SNM (cocaine 12 %, protoxyde d'azote (53/55 cas) sans polyconsommation et par des complications organiques principalement neurologiques (46,5 %) ; – groupe 3 (n = 184) regroupe les polyconsommateurs (96,2 %) de SNM (stimulants (63,6 %, principalement cocaine), héroïne 10,3 %, hallucinogènes 19 %) et SM (BZD 55,4 %, gabapentinoides 31,5 %, opioïdes 28,3 %) associés à des complications organiques ou addictologiques (troubles de l'usage 65,2 %) ; – groupe 4 (n = 71), caractérisé par un usage de médicaments psychotropes : antidépresseurs 39,4 %, BZD 28,2 %, methylphénidate 14,1 %, anti-histaminiques-H1 53,5 % sans consommation de SNM excepté le cannabis (22 %), associé à des complications psychiatriques et organiques. Les groupes 1 et 4 sont majoritairement des jeunes entourés contrairement aux groupes 2 et 3. Le groupe 3 représente majoritairement des jeunes non scolarisés (63,2 %). Le groupe 4 (SM) regroupent les consommateurs les plus jeunes (10–15 ans), notamment des filles. Les niveaux d'usage en France, les complications recensées en addictovigilance et les signaux émergents montrent la nécessité d'une surveillance accrue et la mise en place de campagnes de prévention adaptées à chaque profil de consommateurs.

Background Since the appearance of zolpidem on the market, the occurrence of serious cases of abuse, misuse and dependence have come to the attention of authorities. In view of the increase in the number and severity of cases among zolpidem users and the predominant presence of zolpidem in falsified prescriptions, the French Health Authorities implemented part of the narcotics regulation for zolpidem in April 2017. The objective of this article was to describe the evolution of the abuse, dependence and misuse of zolpidem. Methods We used three data sources: (i) zolpidem is a reimbursable and strictly prescription drug in France. Medic'AM is a public database that indicates the number of tablets reimbursed each month in France for each reimbursable drug. This database has been analyzed as a proxy of the exposure of the French population to zolpidem; (ii) all French cases of drug dependence or abuse reported by health professionals (regulatory obligation) and (iii) an epidemiological tool based on the surveillance of falsified prescriptions over two periods: the 3-year period before the regulatory measure (2014-16) and the 3-year period after the regulatory measure (2018-20). Results This regulatory change had two immediate consequences: a sharp decline in falsified prescriptions and a decrease of similar to 57% between the two study periods in the zolpidem reimbursement data. Markers of problematic consumption remained after the regulatory change with worsening cases, particularly for people who were genuinely dependent and/or had comorbidities or misusers for whom zolpidem was the substance of interest, whose proportion increased significantly in the addictovigilance notification system, from 43.6% (N = 107) to 59.3% (N = 127) (P < 0.01). Conclusions Further monitoring is needed in light of these persistent markers of problematic consumption.