OBJECTIVE:Cocaine use disorder (CocUD) remains a significant public health concern, with elevated mortality rates. Severe psychiatric disorders frequently co-occur with CocUD, possibly associated with an increased frequency of childhood trauma and with lower resilience - the capacity to overcome traumatic life events, compared to the general population. This study aimed to investigate the relationship between psychiatric severity, resilience and childhood trauma in treatment-seeking CocUD outpatients. METHODS:We analyzed the data from a multicenter, cross-sectional study, totalizing 305 CocUD outpatients recruited at specialized addiction care centers. Psychiatric severity was quantified using a custom composite score calculated as the sum of lifetime suicide attempts, psychiatric hospitalizations, and current psychotropic medications. Resilience and childhood trauma were assessed using validated instruments: the Connor-Davidson Resilience Scale (CD-RISC) and the Childhood Trauma Questionnaire (CTQ). The characterization of sociodemographic and clinical characteristics related to CoCUD allowed us to conduct unadjusted and adjusted analyses of associations between trauma, resilience and psychiatric severity. RESULTS:The sample was predominantly male (77%), aged 38 ± 8.7 years. Mean age at onset of CocUD was 28 ± 8 years, and most patients were diagnosed with a comorbid substance use disorder (62% alcohol, 61% cannabis, 43% benzodiazepines and 49% opioid use disorder). Mean psychiatric severity score was 4.2 ± 10.3. Most patients reported at least one childhood abuse type (56.5 +/- 14 for the US version). The mean CD-RISC score was 47.3 ± 13. The mean CTQ score was 47 ± 17. Poisson regression showed a significant inverse relationship between psychiatric severity and total CD-RISC score (p =. 005), with a small effect size (β = -0.01). Psychiatric severity was independently but positively associated with greater CTQ total scores (p = 1.2 x 10-8, β = 0.01), female gender (p = 9.8x10-8, β = 0.41) and comorbid benzodiazepine use disorder (p = 8.7x10-10, β = 0.45). CONCLUSIONS:Although the psychiatric severity score was built arbitrarily, it showed complex interactions with resilience and trauma among CocUD outpatients. These findings underscore the importance of systematically assessing childhood trauma and developing resilience-focused psychotherapies for managing severe CocUD. Psychiatric severity may be measured using simple clinical variables to further tailor these interventions.

Chemsex refers to sexualized drug use among men who have sex with men (MSM). Chemsex practices lead to problematic substance use, but sexuality can also deviate toward loss of control and harmful consequences, leading to sexual addiction. However, the determinants of sexual addiction in chemsex have been poorly investigated so far. In a 353-individual sample of MSM seeking addiction treatment for problematic chemsex, sexual addiction was screened using the Sex Addiction Screening Test. Sociodemographic and clinical characteristics were also assessed, including an assessment of all drugs reported as problematic by participants, but also psychiatric history, including psychiatric hospitalizations, other medical conditions, and at-risk practices of chemsex (e.g., slam, that is, injection drug use), or previous history of overdose, respectively. Using a stepwise logistic regression model, we explored the factors associated with sexual addiction. Multivariable analyses found that, compared to other MSM, those with sexual addiction (n = 39, 11.0

Abstract Background Drug consumption rooms (DCRs) have been developed in cities with open drug scenes, with the aim to reduce drug-related harm. In Lyon, France's second-largest city, there is no distinct drug use area, which raised doubts regarding the need for a DCR. Methods We conducted a face-to-face survey of 264 people who use drugs (PWUDs), recruited in harm reduction or addiction treatment centers, in the streets or in squats. We assess their willingness to use a DCR, and we collected sociodemographic and medical features. Bivariable comparisons and analyses adjusted for sociodemographic parameters explored the association between willing to use a DCR and other variables, thus providing crude (ORs) and adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Results In total, 193 (73.1%) PWUDs accepted to participate (mean age 38.5 ± 9.3 years; 80.3% men). Among them, 64.2% declared willing to use a DCR. Being treatment-seeker (aOR 0.20, 95% CI [0.08–0.51]; p < 0.001) and not living alone (aOR 0.29; 95% CI [0.10–0.86], p = 0.025) were negatively associated with willing to use a DCR. By contrast, receiving precarity social insurance (aOR 4.12; 95% CI [1.86–9.14], p < 0.001), being seropositive for hepatitis C (aOR 3.60; 95% CI [1.20–10.84], p = 0.022), being cannabis user (aOR 2.45; 95% CI [1.01–5.99], p = 0.049), and reporting previous problems with residents (aOR 5.99; 95% CI [2.16–16.58], p < 0.001) or with the police (aOR = 4.85; 95% CI [1.43–16.39], p = 0.011) were positively associated. Conclusions PWUDs, especially the most precarious ones, largely supported the opening of a DCR in Lyon, a city with no open drug scene.

Introduction: Suicide attempts have been associated with both cocaine use disorder (CocUD) and childhood trauma. We investigated how childhood trauma is an independent risk factor for serious and recurrent suicide attempts in CocUD. Method: 298 outpatients (23% women) with CocUD underwent standardized assessments of substance dependence (Diagnostic and Statistical Manual—mental disorders, fourth edition, text revised), impulsiveness, resilience, and childhood trauma, using validated tools. Suicide attempts history was categorized as single vs. recurrent or non-serious vs. serious depending on the lifetime number of suicide attempts and the potential or actual lethality of the worst attempt reported, respectively. Bivariate and multinomial regression analyses were used to characterize which childhood trauma patterns were associated with the suicide attempts groups. Results: 58% of CocUD patients reported childhood trauma. Recurrent and serious suicide attempts clustered together and were thus combined into “severe SA.” Severe suicide attempt risk increased proportionally to the number of childhood traumas (test for trend, p = 9 × 10−7). Non-severe suicide attempt risk increased with impulsiveness and decreased with resilience. In multinomial regression models, a higher number of traumas and emotional abuse were independently and only associated with severe vs. non-severe suicide attempts (effect size = 0.82, AUC = 0.7). The study was limited by its cross-sectional design. Conclusion: These preferential associations between childhood trauma and severe suicide attempts warrant specific monitoring of suicide attempts risk in CocUD, regardless of the severity of addiction profiles.

BackgroundTake-home naloxone (THN) helps to revert the medical consequences of an opioid overdose among people who use drugs (PWUD). In France, an intranasal THN was available from July 2016 to Dec 2020, which was directly dispensed in addiction centers, after a specific education program. However, this intranasal THN was subsequently removed from the market.ObjectiveTo retrospectively explore the post-dispensing proportion and conditions of use of intranasal THN kits, as well as the preferences for intranasal or intramuscular THN among French PWUD.MethodsBased on medical records, all PWUD who benefit from a dispensation of at least one intranasal THN kit in two French outpatient addiction centers, between July 2016 and Dec 2020, were recontacted by phone in April-May 2021, and asked if they used their kits, and, if yes, how. An additional question also explores whether French PWUD preferred being provided with intranasal or intramuscular THN kits.ResultsFive hundred thirty-four (534) PWUD were provided a THN kits, but only 188 (35.2%) could be joined by phone. Of them, 26 (13.8%) did not remember being trained for and dispensed with a THN kit. Of the 160 PWUD interviewed, only six (3.7%) reported having used their kits because of an overdose, in three cases for themselves, and in three cases for someone else. In all the six situations, the victim of the overdose survived. One hundred and eleven (111; 59.0%) PWUD declared preferring intranasal THN form, while 30 (16.0%) preferred intramuscular kits, and 47 (25.0%) had no preference.ConclusionsCompared to what was found in other countries, the proportion of use of THN was low among treatment-seeking French PWUD. This might be due to a reduced likelihood of overdose in this population, or more possibly to an insufficient interest in THN benefits by French PWUD.

Cocaine-induced transient hallucinations (CIH) are a frequent complication following cocaine intake that is associated with addiction severity. Methods: Two hundred and forty-two non-psychotic and Caucasian lifetime cocaine users were included in a French multicentric study. Clinical variables and dopamine pathway genotype data were extracted and tested with CIH scores using a zero-inflated binomial model, which allows for the exploration of factors associated with occurrence and severity separately. Results: Cocaine dependence (p(occurrence) = 6.18 x 10(-5), p(severity) = 9.25 x 10(-8)), number of cocaine dependence DSM IV-Tr criteria (p(occurrence) = 1.22 x 10(-7), p(severity) = 5.09 x 10(-6)), and frequency of intake during the worst period of misuse (p(occurrence) = 8.51 x 10(-04), p(severity) = 0.04) were associated with greater occurrence and higher severity of CIH. The genetic associations did not yield significant results after correction for multiple tests. However, some nominal associations of SNPs mapped to the VMAT2, DBH, DRD1, and DRD2 genes were significant. In the multivariate model, the significant variables were the number of cocaine dependence criteria, lifetime alcohol dependence, and the nominally associated SNPs. Conclusion: Our study shows that CIH occurrence and severity are two distinct phenotypes, with shared clinical risk factors; however, they likely do not share the same genetic background.

Therapies - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le jeudi 28 janvier 2021

Chronic pain and substance use disorders frequently co-occur. Indeed, chronic pain is highly prevalent, affecting 23–68% of patients receiving opioid agonist treatments (OAT) worldwide. The majority of available estimates come from American studies, but data are still lacking in Europe. We aim to provide European estimates of the prevalence of chronic pain in patients receiving OAT using French data, since France is the first European country in terms of number of patients with OAT. The secondary objectives were to characterize the features and management of chronic pain, as well identify associated risk factors. We conducted a multicenter, cross-sectional study, recruiting patients treated either with buprenorphine or methadone in 19 French addiction centers, from May to July 2016. All participants had to complete a semi-directed questionnaire that collected sociodemographic and medical data, pain characteristics, and licit or illicit drug consumption. In total, 509 patients were included. The prevalence of chronic pain was estimated at 33.2% (95% CI: 29.1–37.3). Compared to non-chronic pain patients, chronic pain patients were older (38.4 vs. 36.1 years, p = 0.006), were more unemployed (66 vs. 52%, p = 0.003), had more psychiatric comorbidities (50 vs. 39%, p = 0.02), and split their OAT for pain management more frequently (24 vs. 7%, p = 0.009). Pain intensity was moderate or severe in 75% of chronic pain patients. Among patients with chronic pain, 15.4% were not prescribed, and did not self-medicate with, any analgesic drugs, 52.1% were prescribed analgesics (non-opioid analgesics, 76.3%; codeine, tramadol, opium, 27.2%; and morphine, fentanyl, oxycodone, 11.8%), and 32.5% exclusively self-medicated with analgesics. Moreover, 20.1% of patients with chronic pain also used illicit drugs for pain relief. On multivariate analysis, variables that remained significantly associated with chronic pain were age [OR = 1.03 (95% CI: 1.00–1.05], p = 0.02], anxiety [OR = 1.52 (1.15–2.02), p = 0.003], and depression [OR = 1.25 (1.00–1.55), p = 0.05]. Chronic pain is a highly prevalent condition in patients receiving OAT, and its appropriate management remains uncertain, since insufficient relief and frequent additional self-medications with analgesics or illicit drugs were reported by these patients. Increased awareness among caregivers is urgently needed regarding a systematic and careful assessment, along with an adequate management of chronic pain in patients receiving OAT.

Les signaux d’addictovigilance portant sur la prégabaline se sont accentués depuis 2018, avec une hausse des notifications des mésusages de ce médicament [1]. Afin d’estimer la prévalence et d’évaluer les modalités d’usage de prégabaline au sein de leurs files actives respectives, 2 Centres de soins, d’accompagnement et de prévention en addictologie hospitaliers (CSAPA) ont conduit une enquête rétrospective et descriptive auprès de leurs patients. Du 9 au 30 avril 2020, tout patient ayant bénéficié d’une consultation en addictologie ou d’une délivrance de médicament de substitution aux opiacés s’est vu proposer un questionnaire relatif à la prégabaline. Administré par un professionnel de santé, ce questionnaire visait à évaluer le niveau de connaissance, la fréquence de consommation et l’existence de critères évocateurs de mésusage comme le mode d’obtention et la nature des effets recherchés. Parallèlement au questionnaire, un dépistage urinaire de prégabaline était ajouté au panel de toxiques habituellement recherchés dans le cadre d’une prise en soins classique. 144 patients ont été inclus sur la période, parmi lesquels 24 (16,6 %) déclaraient connaître la prégabaline, 16 (11,1 %) être consommateurs tandis que 10 (7 %) présentaient un ou plusieurs critères évocateurs de mésusage, concernant le mode d’obtention (n = 9) : obtention tout ou partie par achat sur le marché parallèle (n = 7) ou par don (n = 2) et/ou concernant les effets recherchés (n = 9) : recherche d’effet stimulant et/ou de mieux-être (n = 5), de gestion du manque ou réduction de la consommation d’opiacés (n = 2), de défonce (n = 1) ou encore de sevrage des benzodiazépines (n = 1). Une majorité de ces 10 patients faisait enfin état d’une consommation qualifiée d’occasionnelle (n = 8). Aucun des dépistages urinaires pratiqués n’était positif à la prégabaline. Malgré le faible effectif, nous retrouvons ici plusieurs des caractéristiques pointées par l’analyse des données d’addictovigilance françaises comme internationales [1], [2] : un moyen d’obtention illégal, la recherche d’effets psychoactifs ainsi que la notion d’une utilisation visant à gérer celle des opiacés/opioïdes. Ce premier état des lieux nécessite d’être affiné sur un effectif plus large.

Objective. - France has temporarily authorized addictology centers to use a form of intranasal naloxone (Nalscue (R)) to prevent opioid overdoses. The objectives of this work are to present both the characteristics of the patients included in this device in two hospitals centers and the of the national survey on addiction center's contribution to this new risk reduction tool. Methods. - Patient data are those requested under Nalscue (R) study (inclusion period July 2016 to January 2018). The survey is an online questionnaire distributed to all addiction centers with an email address. Results. - Over this period, in the two addiction centers, 370 kits (35% of the national total) were distributed to 330 patients including 312 opioid users. Of these users, 15% report injecting and 85% are poly-consumers. In 14% of the cases, a patient's relative was formed to administrate the Nalscue (R). Forty kits (30 given away, 6 lost, 4 administered) were renewed to 35 users. Of the 462 addiction centers contacted, 82 (18%) responded. Among 76 structures specialized in opioid addictions, two did not feel concerned and one had no knowledge of the antidote. Fifty-five structures were formed by the pharmaceutical firm. Nine hundred forty-seven patients (58% of the total) were included by 37 centers. Forty-four centers ordered 2458 kits and dispensed 1116 (including kits given out of study). Thirteen structures reported use of Nalscue (R). Conclusion. - The interest of intranasal naloxone is no longer to be demonstrated in a context of opioid overdose, but the preauthorized framework did not allow a major diffusion of the antidote within the population most at risk. Let us hope that the availability in pharmacy can promote its distribution and thus reduce the number of deaths. (C) 2019 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.

La France a autorisé temporairement aux structures d’addictologie l’utilisation de la naloxone intranasale (Nalscue®) pour prévenir les décès par overdose aux opiacés. Les objectifs de ce travail sont de présenter à la fois les caractéristiques des patients inclus dans ce dispositif au sein de deux centres et les résultats de l’enquête nationale sur la contribution des centres de soins, d’accompagnement et de prévention en addictologie (CSAPA) à ce nouvel outil de réduction des risques. Les données patients sont celles demandées dans le cadre du protocole lors de la période d’inclusion (juillet 2016–janvier 2018). L’enquête est un questionnaire en ligne diffusé à tous les CSAPA par mail. Sur cette période, dans les deux CSAPA, 370 kits (35 % du total national) ont été distribués à 330 personnes dont 312 usagers dépendants aux opiacés. Quinze pour cent déclarent s’injecter et 85 % sont poly-consommateurs. Quatorze pour cent de l’entourage a pu être formé à l’utilisation du Nalscue®. Quarante kits (30 donnés, 6 égarés, 4 administrés) ont été renouvelés à 35 usagers. Sur les 462 CSAPA contactés, 82 (18 %) ont répondu. Parmi les 76 structures prenant en charge des usagers dépendants aux opiacés, deux ne se sentaient pas concernées et une ne connaissait pas l’antidote. Cinquante-cinq structures ont été formées par le laboratoire exploitant. Trente-sept centres ont inclus un total de 947 patients (58 % de la totalité). Quarante-quatre centres ont commandé 2458 boîtes et dispensé 1116 (y compris hors autorisation temporaire d’utilisation [ATU]). Treize structures ont rapporté une utilisation du Nalscue®. L’intérêt de la naloxone par voie intranasale n’est aujourd’hui plus à démontrer dans un contexte d’overdose aux opioïdes, mais le cadre de l’ATU n’a pas permis une diffusion majeure de l’antidote au sein de la population la plus à risque. Espérons que la mise à disposition en officine puisse favoriser sa diffusion et ainsi réduire le nombre de décès. France has temporarily authorized addictology centers to use a form of intranasal naloxone (Nalscue®) to prevent opioid overdoses. The objectives of this work are to present both the characteristics of the patients included in this device in two hospitals centers and the results of the national survey on addiction center's contribution to this new risk reduction tool. Patient data are those requested under Nalscue® study (inclusion period July 2016 to January 2018). The survey is an online questionnaire distributed to all addiction centers with an email address. Over this period, in the two addiction centers, 370 kits (35% of the national total) were distributed to 330 patients including 312 opioid users. Of these users, 15% report injecting and 85% are poly-consumers. In 14% of the cases, a patient's relative was formed to administrate the Nalscue®. Forty kits (30 given away, 6 lost, 4 administered) were renewed to 35 users. Of the 462 addiction centers contacted, 82 (18%) responded. Among 76 structures specialized in opioid addictions, two did not feel concerned and one had no knowledge of the antidote. Fifty-five structures were formed by the pharmaceutical firm. Nine hundred forty-seven patients (58% of the total) were included by 37 centers. Forty-four centers ordered 2458 kits and dispensed 1116 (including kits given out of study). Thirteen structures reported use of Nalscue®. The interest of intranasal naloxone is no longer to be demonstrated in a context of opioid overdose, but the preauthorized framework did not allow a major diffusion of the antidote within the population most at risk. Let us hope that the availability in pharmacy can promote its distribution and thus reduce the number of deaths.

Background and Aims: Arrival of direct-acting antiviral agents against hepatitis C virus with high-sustained virological response rates and very few side effects has drastically changed the management of hepatitis C virus infection. The impact of direct-acting antiviral exposure on hepatocellular carcinoma recurrence after a first remission in patients with advanced fibrosis remains to be clarified.Methods: 68 consecutive hepatitis C virus patients with a first hepatocellular carcinoma diagnosis and under remission, subsequently treated or not with a direct-acting antiviral combination, were included. Clinical, biological and virological data were collected at first hepatocellular carcinoma diagnosis, at remission and during the surveillance period.Results: All patients were cirrhotic. Median age was 62 years and 76% of patients were male. Twenty-three patients (34%) were treated with direct-acting antivirals and 96% of them achieved sustained virological response. Median time between hepatocellular carcinoma remission and direct-acting antivirals initiation was 7.2 months (IQR: 3.6-13.5; range: 0.3-71.4) and median time between direct-acting antivirals start and hepatocellular carcinoma recurrence was 13.0 months (IQR: 9.2-19.6; range: 3.0-24.7). Recurrence rate was 1.7/100 person-months among treated patients vs 4.2/100 person-months among untreated patients (P=.008). In multivariate survival analysis, the hazard ratio for hepatocellular carcinoma recurrence after direct-acting antivirals exposure was 0.24 (95% confidence interval: 0.10-0.55; P<. 001).Conclusions: Hepatocellular carcinoma recurrence rate was significantly lower among patients treated with direct-acting antivirals compared with untreated patients. Given the potential impact of our observation, large-scale prospective cohort studies are needed to confirm these results.

A personal history of childhood trauma has been associated with the severity of psychotic symptoms in several disorders. We evaluated retrospectively cocaine-induced psychotic symptoms with the SAPS-CIP and childhood trauma with the CTQ in a clinical sample of 144 cocaine users. The SAPS-CIP score was not statistically associated with the presence or number or intensity of trauma, but was associated with rapid routes of administration (intravenous and smoked) and with frequent cocaine use.