Ordering that so-called weak opioids (tramadol, codeine) be prescribed by secure prescription seemed logical. The share of suspicious prescriptions for these painkillers has almost tripled in ten years. In 2022, tramadol was the leading analgesic product causing death (49 out of 135).
However, pain treatment specialists raised loud cries when the ANSM medicines agency announced its decision applicable to 1 at the end of September.is December. “We knew that we would not be ready in hospital establishments, says Professor Valeria Martinez, president of the SFETD (French Society for the Study and Treatment of Pain). And that there would be perverse effects. »
No digital prescription
Monday, two days before the opening of the SFETD congress, the ANSM pushed back the application date to 1is March. A welcome respite that will not solve everything. In question, the absence of secure digital prescriptions: “ Weak opioid prescriptions affect millions of patients. The proliferation of paper schedulers increases the risk of theft and assault. Until now, secure prescriptions (for strong opioids) were mainly found in pain centers and addiction centers. »
Other public establishments usually only work with digital prescriptions and must adapt to secure these paper documents, train doctors, and adapt their software. “During the Ségur de la santé, it was also promised to secure all prescriptions with the Vitale card. It was supposed to be for January 2025, but the project was seriously delayed”regrets Professor Martinez.
Processing failure
According to the learned society, the obligation to prescribe by secure prescription will necessarily reduce prescriptions. And this is not, according to her, good news: “We should not fall into opiophobia. In France, we tend to have oligoanalgesia, too many patients with poorly treated pain, particularly in emergency rooms. »
The dramatic opioid crisis in the United States has led to widespread distrust of analgesic products. “We don’t have that much left. And we need it, pleads the professor. We talk a lot about addiction and misuse, which exist, which must be monitored, but are still quite few in number. And we forget to say that even very strong painkillers are useful when used correctly. »
The American context is not that of France, insists the doctor: “ We’ve always had a lot more regulations. We can welcome this but it must not turn against patients. »
The right duration
Most of the large-scale studies related to analgesics come from the North American continent regrets the president of the SFETD, while the needs in the treatment of pain are evolving. Ambulatory surgery, which has developed greatly and will continue to do so, induces temporally reduced pain management in the clinic and hospital, but with “a possible rebound effect three days later ».
In 2022, the High Authority for Health published a recommendation for “proper use of opioid medications”, detailing most situations and the duration of use that should be prescribed: “What is most important is the correct duration of use”judges the pain specialist.
Note: Painkillers are classified into three levels: the first brings together products such as paracetamol, ibuprofen and anti-inflammatories. The second refers to weak analgesics (tramadol and codeine). The third, morphine and related products (buprenorphine, fentanyl, hydromorphone, nalbuphine, oxycodone, pethidine).
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