The antidote containing naloxone to urgently stop an overdose of drug or illicit opioids such as heroin is still very far from being easily accessible to all, close and users, denounce the association France Patients Experts Addictions and several specialists .
The situation in France is certainly not commensurate with the opioid crisis in the United States and their more than 70,000 deaths in 2017, according to the Ministry of Health. But "more than 500 overdose deaths, including nearly 80% related to opioids identified in 2017, could have been avoided," he said on the occasion of the international day of awareness and prevention of overdoses , August 31st.
Increase in overdoses due to painkillers
The tendency to increase overdoses in recent years is worrying, especially those due to pain medications, according to Pr Nicolas Authier of the French Observatory of Analgesic Drugs (Ofma). "Between 2000 and 2015, overdose deaths from opioid drugs (excluding heroin and methadone) went from 75 to 200," he says and "it's probably an underestimate." When a pain is exacerbated, the patient can multiply the catches and cause an overdose without there being addiction, he warns.
Antidote kits ready to use to stop the overdose while awaiting the arrival of relief are currently marketed in France: an injectable intramuscular form, the Prenoxad since May 2019, and a nasal spray, the Nalscue (35 euros approximately) since 2018. The latter, not reimbursed for lack of agreement with the public authorities, is found only in hospitals and reception centers and specialized care addictions (CSAPA and CAARUD). However, pharmacies can deliver Prenoxad (23 euros) with or without a prescription. It is reimbursed at 65% only on prescription. France Patients Experts Addictions claims Monday in particular, besides a wide accessibility of the antidote, a refund to 100% on prescription and the diffusion in pharmacy of sprays at affordable prices and free distributions where it is necessary.
"It takes mobilization and training of professionals"
"According to a test conducted with an association of drug users, the antidote was present in only one pharmacy out of forty and two-thirds of pharmacies did not know this product," said Professor Michel Reynaud, president of the Equity Addictions Fund which judges "the procedure too complicated". Pharmacists must order the injectable product directly from the laboratory because it is not referenced by wholesalers.
"It is not enough to make a plan to fight overdoses, it requires mobilization and training of professionals (doctors, pharmacists ...) but also consumers, including those who take opioids against back pain and other chronic pain, and their relatives so that the 80% of deaths recognized as preventable by the ministry are avoided ", launches this specialist.
12 million French people would have recourse every year to a reimbursed prescription of an opioid
It is necessary to find the balance between the good use and the accessibility of the analgesics not to neglect the management of the pain, according to Pr Authier. According to him, 12 million French people resort each year to a reimbursed prescription of an opioid. And, a pain medication, "tramadol is at the forefront in terms of overdose and overdose deaths."
For Albert Caporossi, patient-expert and vice-president of the FPEA, "There are many things to improve" as to provide the emergency services (police, gendarmerie, firemen) spray. He also hopes that "an agreement will intervene quickly on the price of the three new sprays", which will replace the Nalscue whose discontinuation of marketing in France was announced for 2020.