Monitoring of benzodiazepine diversion using a multi-indicator approach

Pauly, Vanessa; Frauger, Élisabeth; Pradel, Vincent; Nordmann, Sandra; Pourcel, Laure; Natali, F; Sciortino, V.; Lapeyre‐Mestre, Maryse; Micallef, Joëlle; Thirion, Xavier

doi:10.1097/yic.0b013e32834967e5

Cited by 26 publications

(18 citation statements)

References 34 publications

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“…Previous studies have highlighted the importance of clonazepam as a diverted drug, but in a French study from 2011, it was only second to flunitrazepam [16]. Another French study from 2010 found that clonazepam was the third most frequently illegally obtained medicinal drug, after buprenorphine and methadone.…”

Section: Discussionmentioning

confidence: 99%

Has Previous Abuse of Flunitrazepam Been Replaced by Clonazepam?

et al. 2015

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Background and Aims: For many years, flunitrazepam was the benzodiazepine of choice among users of illegal drugs. The aim of this study was to investigate to which extent clonazepam use has increased in this population, and whether this was related to increased prescription or because of illegal availability. Methods: We used data from three sources to study the changes in the use of clonazepam: (1) Presence and concentrations of clonazepam and flunitrazepam in blood samples collected from Norwegian drugged drivers; (2) Sales numbers (legal market) for clonazepam, extracted from the Norwegian prescription database (NorPD), and (3) Specific seizures (illegal market) for clonazepam in Norway. Results: In 2004, 13.0% of the analysed blood samples from drugged drivers contained clonazepam, whereas this proportion had increased to 27.7% in 2013. In the same period, the frequency of flunitrazepam in drugged drivers decreased from 16.6% in 2004 to 3.2% in 2013. The number of clonazepam prescriptions decreased, while the number of seized tablets containing clonazepam increased considerably from 2004 to 2013. Conclusions: For the last 10 years, a significant increase in the illegal use of clonazepam has been seen, now replacing flunitrazepam as the most used illegal benzodiazepine in Norway.

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Section: Discussionmentioning

confidence: 99%

Has Previous Abuse of Flunitrazepam Been Replaced by Clonazepam?

et al. 2015

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“…In the context of off-label use of these drugs, a survey on falsified prescriptions should help to monitor their patterns of use and/or misuse [50]. As recently shown with pregabalin [51,52], specific and permanent tools are needed in the area of monitoring of addiction, enabling a multiple-source approach to identify and quantify abuse of or dependence on prescription drugs [53]. …”

Section: Discussionmentioning

confidence: 99%

A European Community Pharmacy-Based Survey to Investigate Patterns of Prescription Fraud through Identification of Falsified Prescriptions

Lapeyre‐Mestre

Gony²,

Carvajal³

et al. 2014

Eur Addict Res

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Aim: To identify prescription drugs involved in falsified prescriptions in community pharmacies in 6 European countries. Methods: A cross-sectional survey among 2,105 community pharmacies in Belgium, France, Italy, the Netherlands, Spain and Sweden was carried out to collect all suspect prescription forms. For each reported drug, the number of reported falsified prescriptions per thousand inhabitants was estimated. A falsification ratio was calculated by dividing the number of reports by the number of defined daily doses per 1,000 inhabitants per day for this drug, computed from national sale or reimbursement data. Results: On 862 prescription forms, benzodiazepines (zolpidem, bromazepam, alprazolam), buprenorphine (as an opioid maintenance drug) and tramadol were the most frequently reported. Depending on their level of use in each country, methylphenidate, morphine and flunitrazepam presented the highest falsification ratios, particularly in Spain, Belgium and France. Conclusions: Stimulants, opioids and some benzodiazepines were the most frequently reported drugs in this survey on falsified prescriptions, but differences between countries were observed.

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“…In the global literature, a range of terms are used to encapsulate prescription drug misuse including abuse, dependence, diversion, misuse, problematic or non-medical use [1,[28][29][30]. As such, our search strategies included twenty-four unique misuse-related terms to capture relevant articles.…”

Section: Terminologymentioning

confidence: 99%

Harmonizing Post-Market Surveillance of Prescription Drug Misuse: A Systematic Review of Observational Studies Using Routinely Collected Data (2000–2013)

et al. 2015

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Background Prescription drug misuse is a growing public health concern globally. Routinely collected data provides a valuable tool for quantifying prescription drug misuse.Objective To synthesize the global literature investigating prescription drug misuse utilizing routinely collected, person-level prescription/dispensing data to examine reported measures, documented extent of misuse and associated factors.Methods We searched MEDLINE, Embase, CINAHL, MEDLINE In Process, Scopus citations and Google Scholar for relevant articles published between January 1 2000-July 31 2013. We screened 10,803 abstracts and retrieved 281 full-text manuscripts. Fifty-two peer-reviewed, English-language manuscripts met our inclusion criteria: an aim/method investigating prescription drug misuse and a measure of misuse derived exclusively from prescription/dispensing data.Results Four proxies of prescription drug misuse were used commonly across studies: number of prescribers, dispensing pharmacies, early refills and volume of drugs dispensed. We identified 89 unique measures of misuse across the 52 studies, reflecting the heterogeneity in how measures are constructed; single or composite; different thresholds, cohort definitions and time period of assessment. Consequently, it was not possible to make definitive comparisons about the extent (range reported: 0.01-93.5%), variations and factors associated with prescription drug misuse.Conclusion Routine data collections are relatively consistent across jurisdictions. Despite the heterogeneity of the current literature, our review identifies the capacity to develop universally accepted metrics of misuse applied to a core set of variables in prescription/dispensing claims. Our timely recommendations have the potential to unify the global research field and increase the capacity for routine surveillance of prescription drug misuse. 3 Key points Prescription drug misuse is increasing globally. This can be monitored readily using routinely collected data; quantifying drug access patterns at the population-level. Our review identified only four common proxies for prescription drug misuse (number of prescribers; number of dispensing pharmacies; volume of drug(s) dispensed; and/or overlapping prescriptions/early refills) yet they were used to derive 89 unique definitions of misuse due to variations in thresholds, or use alone or in combination. We recommend the development of consistent and replicable metrics to facilitate monitoring and comparisons of the extent of prescription drug misuse across health care settings and over time.

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Monitoring of benzodiazepine diversion using a multi-indicator approach

Cited by 26 publications

References 34 publications

Has Previous Abuse of Flunitrazepam Been Replaced by Clonazepam?

Has Previous Abuse of Flunitrazepam Been Replaced by Clonazepam?

A European Community Pharmacy-Based Survey to Investigate Patterns of Prescription Fraud through Identification of Falsified Prescriptions

Harmonizing Post-Market Surveillance of Prescription Drug Misuse: A Systematic Review of Observational Studies Using Routinely Collected Data (2000–2013)

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