This is the drug that made America sick. Oxycodone, marketed in France under the name OxyContin or OxyNorm, is a powerful painkiller at the origin of the “opioid crisis” which has claimed more than 500,000 lives since the beginning of the 2000s in the United States. United. A real health scandal, observed on this side of the Atlantic with a mixture of amazement and disbelief. A touch of superiority, too, fueled by the satisfaction of having escaped the ravages of this opiate. The alert launched these days by the experts of the French Society of Pharmacology and Therapeutics (SFPT) calls out all the more.
As L’Express reveals, these specialists in the study of drugs are concerned about the increase in the consumption of this product in the south-west quarter of France. They see it as a sign that something has changed, and that the health authorities would do well to take heed. “It is not a drug like the others, its history is heavy. At the risk of sounding alarmist, we believe that it is better to take action now rather than risk ending up in an inextricable situation”, insists Professor Francesco Salvo, pharmacologist at the university hospital center (CHU) and head of the Bordeaux regional pharmacovigilance center.
Co-author of an article which appeared on May 20 on PharmacoFact, the general public site of the SFPT, this expert was among the first to refer this question to the National Medicines Safety Agency as well as the regional health agency of New Aquitaine. He explains to us how he became interested in it and why, according to him, it is necessary to quickly inform prescribers and patients in the face of the astonishing distribution of this problematic product in recent years. Interview.
L’Express: How did you realize that the consumption of oxycodone was beginning to slip, particularly in the South West of France?
Francesco Salvo: It is a story that begins in September 2022, from calls from fellow doctors to the regional pharmacovigilance center of the Bordeaux University Hospital. Especially surgeons and anesthesiologists: they were surprised to see that, in their clinics or hospitals, pharmacists offered them oxycodone to replace morphine for their patients suffering from postoperative pain. These colleagues work in different establishments, but the explanations given to them always seemed somewhat the same: less constipation, less kidney problems… We started to look at this more closely, and we realized that there was no There was no pharmacological argument for preferring oxycodone to morphine. We can not say that this product has fewer side effects, it is false. However, some colleagues have told us that it is now the only opioid available to them for their operated patients. This is very striking, because this drug should only be offered as a second line. So we decided to take a closer look at the consumption data.
What have you discovered?
We have pharmacoepidemiology tools built from public health insurance databases that allow us to study the number of consumers per year and per region of each drug. In New Aquitaine, there were 735 patients on oxycodone per 100,000 inhabitants in 2017. In 2021, we rose to 900 per 100,000 inhabitants, an increase of 25% in five years. This is very important, especially since, in the other regions, the increase remains reasonable, from 1 to 2% per year. We are eagerly awaiting the data for 2022, as it was only last year that we received the first reports, and we fear that the latest figures will be even more important. We therefore immediately alerted the local and national health authorities.
Why does this worry you?
We are not yet in a crisis, but the increase in prescriptions is very real. This signal must be taken seriously because of the very heavy history of this drug. In the United States, repeated overdoses did not happen overnight. On the contrary, for seven to eight years, this consumption remained a little under the radar, before leading to the public health problem that we know.
In France, we must act now. All the scientific literature is consistent: this product has a much higher addictogenic potential than morphine, because it plays on the physiological response to dopamine, the reward hormone. But who speaks of reward speaks of addiction.
At the moment, we only have raw data on the number of consumers, but we do not know since when they have been taking this product, and for how long it is prescribed for them. We therefore do not yet have any factual elements to demonstrate that some of them present misuse or a problem with use, but we have requested funding for a research project in this direction. Nevertheless, the head of the Poitiers pain center, who also has an addiction consultation, told us that the profile of patients followed in her department for addiction has changed recently, with a higher proportion of individuals on oxycodone. Even if it is only fragmentary information, they are concordant.
How do you explain this increase in consumption in France? Should we see this as a voluntary action by the laboratory, a bit like in the United States, where its owners, the Sackler family, are accused of having lied about its addictive properties to promote their product?
The increase in prescriptions seems to have started in hospitals and clinics in the region. In these establishments, pharmacists are responsible for purchases, and they manage “as good fathers”, trying to negotiate discounts. When a laboratory wants to push a drug, it can sell it off to these buyers, knowing that then general practitioners will extend hospital prescriptions. Our data also indicate a vertiginous increase in prescriptions, especially among surgeons and anesthesiologists in the clinic. The manufacturer must navigate financially, since, in city pharmacies, the treatment is reimbursed at a higher fixed price. This is a well-known technique, and it could explain why, in certain establishments, my surgeon colleagues have fewer alternatives to offer their patients.
In the United States, the laboratory had said that its drug was less addictive than morphine, which is false. Nothing like that has been reported to me here. On the other hand, I am surprised by the received ideas that circulate on oxycodone according to which this product would present the same safety profile as morphine, which is not true: it can cause drug interactions and it would present more risks. cardiac arrhythmias, especially in the event of an overdose. Moreover, its action is equivalent in terms of analgesia.
Since this drug has wreaked havoc in the United States, shouldn’t it be withdrawn from the French market?
Many pain medications have already been withdrawn in recent years, and practitioners lack therapeutic alternatives. This treatment can be useful, provided that the necessary precautions are taken. It should not be offered as a first-line treatment, but reserved for cases where morphine is not enough. Even more than other opioids, it must be prescribed with great care to patients known to be more at risk of addiction – people who have already experienced use disorders with other products. , or who have suffered domestic violence. Still, for the moment, we have the impression that its use is “democratizing”, which should not be the case.
What can be done in these conditions?
We are fortunate to still be at a time when it is possible to act, to carry out preventive actions to avoid reaching a threshold where it would be difficult to go back. In particular, this should involve training general practitioners and, more generally, all prescribers in pain management. We must not let patients suffer, but we must be able to limit the risks associated with the products available to a minimum.