France in an emergency – Liberation

Fighting overdoses, preventing risks and distributing naloxone in the best possible way: these are the projects that the country must face to avoid an increase in deaths linked to drug consumption.

It is an epidemic that is less talked about but which is rife in the shadows. This Tuesday, on the occasion of the international overdose awareness day launched in 2001, associations and health professionals alert the public authorities to the damage linked to overdoses. And to recall that France is far from being ready to face an outbreak of overdoses. Beyond the delays in risk reduction and prevention, the latest figures published in April by the National Medicines Agency (ANSM) on data recorded in 2019 are eloquent. They reveal an increase in deaths linked to the use of opioids, legal or not. Thus, in 2019, some 450 people died in France following an opioid overdose and 77 after having overdosed on cocaine.

In France, addiction to opioids causes five deaths per week. But these data are very largely underestimated. In France, men are predominantly affected by overdoses, with an average age of 38.7 years. Generally, people die there due to an overdose linked to a substitution drug such as methadone more than after a shoot. heroin.

Since 1999 across the Atlantic, the opioid crisis has killed nearly half a million people. Some 130 people die there every day from an overdose of highly addictive analgesics. “The main problem is in front of us, assure Bertrand Leibovici, addictologist specializing in reducing the risks associated with drug addiction. We cannot exclude that there is a massive arrival of Fentanyl in continental Europe. ” Fentanyl or non-pharmaceutical fentanyloids from the underground market are 100 to 10,000 times more potent than morphine. This is the case with Carfentanyl, the most potent of the opioids, which has no indication in human medicine but is used to “Lull large mammals such as elephants or rhinos to sleep”, reminds the doctor.

In England, Wales but especially in Scotland, the number of drug-related deaths has never been higher than in 2020, according to a report published in early August. A rate of 76.7 per million inhabitants, a jump of 3.8% compared to 2019. Figures never seen since the introduction of these surveys in 1993. A trend linked to the consumption of opiates but also increased deaths from other substances such as cocaine. For Bertrand Leibovici, “Great Britain sets the tone for the rest of continental Europe in terms of clothing, music, and drugs.”

In France, too, the trend in consumption is worrying. For Bertrand Leibovici, it is important to remember that overdoses are “Medical emergencies that take place in a context of legal insecurity” : “The government should make a commitment not to prosecute people who call for help to report an overdose. And get the message across to them. Because often people run away and leave the person alone. ” For the practitioner, another way to prevent overdoses would be to provide “The family but also the comrades of” getting high “of the naloxone kits [antidote aux opiacés ndlr]».

Faced with overdoses, health professionals and consumers have a formidable weapon: naloxone. First marketed in the 1970s in the United States, it is a molecule which, once injected or inhaled, can instantly stop overdose. An essential remedy. “But naloxone is not enough. The user should be monitored after the dose has been administered. Especially if he overdosed on methadone, which is a heavy opioid. Three or four hours after receiving the naloxone, the user can take one again. Methadone stays in the body for a long time, while naloxone has a very short duration of action ”, insists Bertrand Leibovici. For Nicolas Authier, psychiatrist specializing in pharmacology and addictology, the French situation is not comparable to that of the United States or England: “Doctors there prescribe a lot more opioid analgesics than we do. The population is therefore much more exposed. This is why France must now distribute naloxone in order to avoid a similar crisis. When it comes to overdose, prevention is effective. Healing is often too late. ”

In 2019, on the occasion of International Overdose Awareness Day, the Ministry of Health published a roadmap to deal with opioid overdoses. Objective: to expand the naloxone delivery circuit and provide kits to emergency services, firefighters and police. Since December 2020, after the withdrawal from the market of the sole distributor, only one form of naloxone has been available: Prenoxad, injected intramuscularly. The Aides association broadcast on Tuesday a documentary to warn about the shortage in the country of naloxone nasal spray, easier to use and without risk. A French specificity, unlike many European countries which have both forms. “The absurdity of this situation reveals a lack of political will: solutions exist, in particular parallel imports which consist in bringing from other countries a drug not distributed in France”, denounces Camille Spire, president of Aides in a press release.

An inter-association press release, published Tuesday morning reminds the government that it is “Time to act”. And points to the rate of 15% of deaths from additional overdoses during the pandemic. For Nathalie Latour, general delegate of the Addiction Federation, a “More proactive and sustained action” authorities is urgently needed: “Containment and the pandemic have made it possible to unlock projects that have been on hold for nearly eighteen months, such as the communication campaign outing in June to raise awareness of the problem of overdoses […] But the authorities had also told us that the nyxoid [un analgésique à base d’opiacés ayant largement contribué à la crise des opioïdes (1)] , the new nasal form, was to be available at the end of 2020. This is still not the case. We are moving forward, but too timidly. ”

(1) Nyxoid is developed by the firm Mundipharma, a subsidiary of the giant Purdue Pharma, owned by the Sackler family, condemned for the ravages of OxyContin in the United States.


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