Three months of respite. Faced with the outcry from caregivers and the risk of threat of pain management, the Medicines Agency announced the postponement of the measure of passage on secure prescription of tramadol and codeine. Originally scheduled for 1is December, it will finally take place on 1is mars 2025.
“The reduction in the maximum prescription duration of medicines containing codeine or dihydrocodeine to 12 weeks is also deferred until March 1, 2025”informs the Agency. Additional time for “to facilitate the transition to these new measures for healthcare professionals and ensure patients have access to their treatments”.
A threat to support?
Announced at the end of September, this transition to a secure prescription for tramadol and codeine was described as hasty by some colleagues. Philippe Besset, president of the Federation of Pharmaceutical Unions of France (FSPF) had thus denounced “the eagerness of the ANSM”Who “threatened pain management”.
Main reason put forward by the union: the execution of secure prescriptions in digital format, not yet integrated into certain LGOs, a source of potential hiccups during delivery. “This hasty delay leaves pharmacists with only two choices, each as unsatisfactory as the other: waste a significant amount of time obtaining a compliant paper prescription or, in fairly frequent cases such as the prescriber being unreachable, refuse outright provision of treatment »then regretted the union, which “did not accept any of these choices”.
Pain specialists warn of risk of opiophobia
On November 20, the French Society for the Study and Treatment of Pain (SFETD) for its part warned of a risk “opiophobia”. “The fear of excesses should not lead to opiophobia, which risks aggravating the phenomenon of oligoanalgesia (failure to recognize and provide analgesia in patients suffering from pain) already present in France, particularly in situations of emergency “warns Professor Valéria Martinez, president of the SFETD, via the press.
While 12 million French people are prescribed opioids each year, and this increasing consumption is worrying, the SFETD recalls that the situation in France is “incommensurable” with the opioid crisis in the United States. “We need to be as concerned about the risks of overprescribing as we are of underprescribing when opioids are necessary”even underlines Professor Valéria Martinez.
Not opposed to secure prescription, however, the learned society nevertheless warns against a hasty measure, when the software is not suitable and the secure schedulers risk running out within the allotted time.
“Patient education, pain training for medical students and continuing education could be much more effective levers than fear or excessive restrictions imposed on prescribers,” thus decides the SFETD.
17% suspicious prescriptions for tramadol
As a reminder, according to the DTA 2022 survey, 135 deaths linked to opioids (low and high) were recorded throughout France. That is a death rate of around 0.2 deaths per 100,000 inhabitants. “A figure 100 times lower than that of the United States”recalls the SFETD.
At the same time, according to the OSIAP survey, the percentage of suspicious prescriptions concerning tramadol increased from 6.9% in 2013 to 17% in 2022. Of approximately 2,600 falsified prescriptions, 457 concerned Tramadol, 416 codeine for its antitussive specialties and 293 for indications against pain.
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