Résumé
NPS represent significant analytical and interpretive challenges to forensic and clinical toxicologists. In that way, the addictovigilance network is a French specificity, which implemented to collect, analyze, evaluate and disseminate clinical and sanitary information on NPS. A risk assessment of these NPS can lead to a narcotic classification by the Committee on Narcotic Drugs and Psychotropic Drugs coordinated by the French Medicines Agency. Methods Analysis of spontaneous notifications (NotS) concerning NPS use, reported to the FAN from 2009 to 2017, was completed by the data of observation of illegal drugs and misuse of psychotropic medications (OPPIDUM), and deaths related to the abuse of medicine and substances (DRAMES) surveys.
In total, 874 cases of NPS uses were reported between 2009 and 2017, 692 cases were reported via NotS (2.3% of all notifications), 148 cases were obtained via OPPIDUM survey (0.3% of included patients) and 34 were NPS-related deaths reported via DRAMES survey (1.2% of included patients). In regard to NotS data, synthetic cathinones represent the majority of NPS reported cases (60% in 2017), followed by synthetic cannabinoids. Main adverse effects observed were psychiatric effects (agitation, confusion, euphoria, aggressiveness, hallucinations, insomnia and substance use disorders), cardiovascular effects (tachycardia, chest pain, myocardial infarction) and neurological effects (somnolence, drowsiness, convulsions, comas). In regard to OPPIDUM data survey, even if NPS users do not seem to be care into these “classical” structures for drug users, an increase is noted (0.5% in 2016; 0.8% in 2017). The main reported NPS declared to be consumed was 3-MMC (12% in 2015, 23% in 2017). In regard to DRAMES data survey, NPS-related deaths increase during the period and represent 6% of direct deaths by an illicit drug in 2015. The main NPS detected were cathinones (3-MMC, 4-MEC, mephedrone), benzofurans (5-APB), benzodiazepine designers, and synthetic opioids. The number of cases involving at least one NPS increases significantly from 2015 with the appearance of new products every year, including a fentanyl analog in 2016. Only 148 cases out of 874 (17%) are confirmed by the analytical toxicology.
An increase in the number of reports is observed each year in each of the tools with a worrying increase in the number of deaths. In recent years, the emergence of synthetic opioids (fentanyloides, AH-7921 and U47700), synthetic benzodiazepines and stimulants from psychostimulant medicines (phenidates and N-methyl4-4 difluoromodafinil) is to note.
In the context of the opioid crisis in North America, addictovigilance is a major contributor to the monitoring of abuse and dependence cases. The arrival of drug mimicking medicine appears to represent a worrying shift that could lead to uncontrolled use. Addictovigilance is the watchword in 2019 with the help of toxicologists.