235.8 billion euros, or 8.9% of gross domestic product: this is, according to INSEE, the – dizzying – amount of consumption of “care and medical goods” in France in 2022. In this set, which covers a very vast field (hospital and community care, dental and optical care, analysis laboratories, etc.), the consumption of medicines amounts to 32.8 billion eurosup 5.3% compared to 2021.
In a context of increasing needs (aging of the population, increase in chronic diseases), is this development nevertheless alarming?
“It is difficult to make an overall judgment, because patients are in clinical situations whose needs are assessed on an individual level,” points out Alexandre de La Volpilière, deputy director general of operations at the National Security Agency. medicines and health products (ANSM). In the vast majority of cases, consumption is justified. The question is more that of the correct prescription: however, for certain populations and certain categories of drugs, the problem of overprescription is real. »
Too many antibiotics and benzodiazepines
Despite a continuous decline over the past 10 years, France remains the 4th European country most fond of antibiotics (behind Greece, Romania and Bulgaria). We are even at the top of the ranking in terms of consumption of oral antibiotics. If these drugs are essential in the treatment of infectious diseases, their massive and often inappropriate use promotes the appearance of bacterial resistance.
The phenomenon of antibiotic resistance is also considered by the World Health Organization (WHO) as “one of the most serious threats to global health, food security and development”. In France, each year, 125,000 infections and 5,500 deaths are attributable to this scourge.
In the field of benzodiazepines (this name includes around twenty medications usually prescribed to relieve anxiety, stress, or insomnia), France is also a bad student in Europe, ranking second on the podium. Prescriptions are particularly increasing among the youngest: according to a report from the High Council for the Family, Childhood and Age, the use of antidepressants jumped by 62% among children and adolescents between 2014 and 2021. The increase is 48% for antipsychotics and even 155% for hypnotics and sedatives.
“This overconsumption can have particularly serious individual and collective consequences: international studies show, for example, a 60 to 80% increase in the risk of road accidents associated with the consumption of benzodiazepines, indicates Alexandre de La Volpilière. Reducing this consumption has become a public health issue for France. »
The ANSM is also working, with field stakeholders, on the second part of its campaign on the proper use of medicines, which will be devoted to this issue.
Risks of complications in the event of polypharmacy
Overconsumption of medications also exposes more side effects (which is called “drug iatrogenics”). This risk particularly concerns those over 65. “By nature, elderly people are polypathological and therefore polymedicated,” summarizes Dr Éric Baseilhac, president of the Association Good Use of Medication (ABUM). They tend to consume a lot of medications and at the same time, they have a physiology that weakens them, since the purification organs – the kidney and the liver – often function less well. »
“The use of several families of medications in the same patient can lead to complications,” adds Dr Pierre de Bremond d’Ars, general practitioner in Malakoff (Hauts-de-Seine). We have models and tools to try to limit interactions as much as possible. But, from more than 4 drugs taken together, it becomes complicated. We now know that some hospitalizations, care and use of emergency services could be avoided because they are linked to this iatrogenics. »
Environmental and economic issues
Beyond health issues, overconsumption of medications also raises questions from an environmental point of view. According to studies carried out by the Shift Project, the French health system is responsible for almost 8% of the country’s greenhouse gas emissions, and these are drug purchases that weigh the most in the balance (29% of the total). Throughout their life cycle (from their production to their elimination, including their transport), pharmaceutical products have a significant impact on the planet.
« Every medicine has a cost in water and energynot to mention that it is often packaged in plastic, underlines Dr Bremond d’Ars. We also release chemicals into nature through urine and feces (1). If we place ourselves in the perspective of a 21st century medicine that also preserves ecology in order to preserve health, the fewer drugs we give to patients, the less significant the effects on ecosystems will be. »
The balance of the health system is also at stake: in a context of seeking budgetary control, avoiding long prescriptions saves money. For certain drugs which are experiencing supply tensions, excessive or inappropriate use can also “deprive certain patients of the opportunity to benefit from appropriate treatment”, warns the deputy general director of operations of the ANSM.
Towards “sobriety of prescriptions”
How to respond to these challenges? Public authorities, health professionals and operators in the sector have been campaigning for several years for more “responsible” consumption of pharmaceutical products.
In the new medical agreement signed between Health Insurance and the unions of independent doctors (2), the principle of “sobriety of prescriptions” (“ prescribe less whenever possiblewith equivalent relevance and quality of care”) is also part of the commitments of practitioners. Among the objectives are also the fight against antibiotic resistance (“ reduce the prescription of antibiotics 10% from 2025 and 25% by 2027) and the reduction of polypharmacy. A “deprescription consultation for hyperpolymedicated patients” has also been created to support people over 80 whose prescription includes more than 10 lines of treatment.
“The players are mobilizing in the right direction and things are being put in place, but we must not let our guard down,” believes Éric Baseilhac. Changing behavior regarding the proper use of medication is a long-term process. This term “sobriety” is very interesting, because it invites us to view medicine as a precious commoditywhich should not be misused or wasted. It also forces us to question ourselves, collectively, about our relationship to medications: are we dependent on them? We live in a society which, due to lack of time and availability of caregivers, tends to favor “trigger” treatments: medications are given to respond to symptoms rather than diagnoses. And this encourages the multiplication of drugs. »
Other factors can also explain the situation. “For a very long time we had a paternalistic model, where the doctor ordered the patient to take this or that medication,” analyzes Pierre de Bremond d’Ars. The pharmaceutical industry also played a major role in the equation. Today, we are more in a collaboration model which requires patient participation. Our role is to support them as a whole and offer them support that is broader than the medication itself. This is the wealth and the heart of our profession. »
- Conventional wastewater treatment plants cannot completely remove pharmaceuticals from wastewater.
- The medical convention is a set of texts which governs the links between private doctors and Health Insurance. It is concluded for a period of 5 years.
