Prevalence of zolpidem use in France halved after secure prescription pads implementation in 2017: A SNDS database nested cohort study

Caillet, Pascal; Rousselet, Morgane; Gérardin, Marie; Jolliet, Pascale; Victorri-Vigneau, Caroline

doi:10.1371/journal.pone.0228495

Cited by 13 publications

(14 citation statements)

References 25 publications

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“…Despite these two limitations, we can assume that this legal framework reduced the consumption of zolpidem and so should have beneficial effects, such as the reduction of side effects related to zolpidem, especially in young occasional consumers. Our results showed a decrease in the use of zolpidem, and are in agreement with those of other authors who have worked on this question [20,[34][35][36]; however, we also showed that this decrease was different according to the age. For patients over 65 years old, the measure was less effective overall.…”

Section: Discussionsupporting

confidence: 93%

“…The French national ZORRO study (ZOlpidem and the Reinforcement of Regulation of prescription Orders) [20], a study which aim to measure the impact of the implementation of the regulatory framework concerning the zolpidem in France, showed a decrease in prevalence of zolpidem users in general population. However, older people were not specifically studied, as it is common for them to be dependent [4].…”

Section: Introductionmentioning

confidence: 99%

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Regulatory Framework Implementation for the Prescription of Zolpidem in France, What Impact in the Older People?

Jobert

Istvan

Laforgue

et al. 2021

IJERPH

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Background: Zolpidem is one of the most prescribed hypnotic drugs. In 2001, the World Health Organization alerted a risk of pharmacodependence associated with zolpidem. The French health authority decided in 2017 to enforce security on the prescription of zolpidem to reduce those risks. The aim of our study was to evaluate the impact of regulatory framework implementation, secure prescription pad, on the prevalence and incidence of prescriptions of zolpidem according to the age. Methods: This study was based on an observational study using the French healthcare data system. Two age categories were defined: “younger” and “older” (<65 years, ≥65 years); in order to study the evolution of prevalence and incidence of zolpidem use in our two groups, two periods were defined, before and after the implementation of the measure. Results: The prevalence decreased in the younger population by 51% (4012 vs. 7948 consumers), while that of the older population decreased by 42% (4151 vs. 7282). This difference in our two groups, with a greater decrease in the younger people, is statistically significant compared to the older people. Conclusion: Our study showed that regulatory framework implementation and mandatory secure prescription pad is more effective for decreasing prevalence of zolpidem prescription for younger people compared to older people.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Regulatory Framework Implementation for the Prescription of Zolpidem in France, What Impact in the Older People?

Jobert

Istvan

Laforgue

et al. 2021

IJERPH

Self Cite

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“…This decreased prevalence seemed to be mainly due to a high number of treatment discontinuations after the measure: 4.3 times higher than the number of treatment initiations. 11 Among users who have discontinued zolpidem use, two situations can be distinguished: either they have completely stopped using sedatives and hypnotics or they have started using other medications.…”

Section: Introductionmentioning

confidence: 99%

Change in the regulatory framework for zolpidem: What is the impact on the landscape of the prescription of sedative medications? The French national ZORRO study

Istvan

Caillet²,

Rousselet

et al. 2021

Brit J Clinical Pharma

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In recent years, zolpidem has been the subject of numerous reports of misuse, abuse and dependence. In view of these risks, the French drug agency (ANSM) decreed in April 2017 the implementation of secure prescription pads. The objective of this study was to evaluate the impact of this regulatory measure on the prescription of zolpidem and other sedative medications (zopiclone, benzodiazepines and antihistamines) in long-term users of zolpidem and associated factors. Methods:We performed a historical cohort study using data from the Generalist Sample of Beneficiaries (EGB). All patients aged over 18 years old who were longterm users (at least 3 months) before the measure were enacted. We analysed the reimbursement trajectories of zolpidem, zopiclone, benzodiazepines and antihistamines (hydroxyzine and alimemazine) up to 2 years after the measure using a state sequence analysis.Results: Overall, 2502 patients were analysed. A four-cluster typology was identified: continuation of zolpidem (n = 1044, 42%), discontinuation of sedative medications (n = 766, 31%), change to zopiclone (n = 537, 21%) and change to hypnotic benzodiazepines (n = 155, 6%). The most frequently prescribed hypnotic benzodiazepine was lormetazepam. We identified age, sex, treatment for psychiatric or addictive disorder and volume of zolpidem use before the measure as factors associated with different reimbursement trajectories after the regulatory change. Conclusion:The regulatory change for zolpidem prescriptions reduced exposure to zolpidem among long-term users and also had a broad impact on prescriptions of other sedative medications. Switching to other medications that also present a potential risk of abuse or dependence should be carefully monitored.

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“…Since 2017, French regulations for zolpidem prescription impose the use of secure prescription booklets, a thorough specification of dosage and quantity, and maximal 4 weeks treatment duration. 46 An evaluation of these measures has demonstrated efficacy, with a drastic decrease of zolpidem use in the general population. 46 This might be an interesting lead for future health policies in our country.…”

Section: Discussionmentioning

confidence: 99%

“… 46 An evaluation of these measures has demonstrated efficacy, with a drastic decrease of zolpidem use in the general population. 46 This might be an interesting lead for future health policies in our country.…”

Section: Discussionmentioning

confidence: 99%

Trends in benzodiazepine receptor agonists use and associated factors in the Belgian general older population: analysis of the Belgian health interview survey data

Pétein

Spinewine

Henrard

2021

Therapeutic Advances in Psychopharmacology

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Background: Benzodiazepine receptor agonists (BZRA), which include benzodiazepines and z-drugs, are commonly prescribed for insomnia and anxiety in older adults, and used often long term. Yet, the risk–benefit ratio of BZRA use in older adults may be unfavorable and many recommendations suggest avoidance or a maximal treatment duration of 4 weeks. The aim of this study was to describe trends of BZRA use in older adults and associated factors. Methods: Using data from the Belgian Health Interview Survey in 2004 ( n = 3594), 2008 ( n = 2917), and 2013 ( n = 2048), prevalence standardized for age, sex, and region were calculated to assess trends of BZRA use in people ⩾65 years. Analysis of associated factors to BZRA use was performed using a sub-sample of 2013 data for which variables assessing sleeping disorder and anxiety disorder were not missing ( n = 1286). Variables from seven main topics were explored using multivariate logistic regression: socio-demographic factors, geriatric factors, comorbidities, subjective health and mental health indicators, social health indicators, medication use and healthcare services use. Results: Overall, standardized prevalence of BZRA use decreased significantly between 2004 and 2013 [22% to 18%, prevalence difference (95% confidence interval, CI): −4.0% (−6.8; −1.3)]. Factors associated with BZRA use in multivariable analysis included female gender [adjusted odds ratio (aOR) (95%CI) : 1.62 (1.14; 2.29)], poor mental health [aOR (95%CI): 1.73 (1.13–2.63)] a fall in the past 12 months [aOR (95%CI): 1.52 (1.02; 2.26), reporting a sleeping disorder [aOR (95%CI): 1.92 (1.35; 2.72)], polypharmacy [aOR (95%CI): 2.51 (1.75; 3.60)], and trazodone use [aOR (95%CI): 4.05 (1.64; 10.21)]. Conclusion: Despite an encouraging decline observed from 2004 to 2013, BZRA use remained highly prevalent in Belgian older adults. Promotion of alternatives to BZRA in treatment of sleeping problems need to be continued. Among BZRA older users, women, the oldest (⩾85 years) and high-risk subgroups should be targeted in deprescribing interventions.

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Prevalence of zolpidem use in France halved after secure prescription pads implementation in 2017: A SNDS database nested cohort study

Cited by 13 publications

References 25 publications

Regulatory Framework Implementation for the Prescription of Zolpidem in France, What Impact in the Older People?

Regulatory Framework Implementation for the Prescription of Zolpidem in France, What Impact in the Older People?

Change in the regulatory framework for zolpidem: What is the impact on the landscape of the prescription of sedative medications? The French national ZORRO study

Trends in benzodiazepine receptor agonists use and associated factors in the Belgian general older population: analysis of the Belgian health interview survey data

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