Background: Few data are available concerning the diversion and abuse of morphine sulfate. In France, morphine sulfate abuse is currently investigated by the health authorities. The aim of our study was to provide data on morphine sulfate abuse in France, collected during the period 1996–2011. Methods: The French monitoring system for psychoactive medication abuse collected data from several sources: spontaneous reporting of cases of abuse or dependence (NotS; ‘Notifications Spontanées’), specific periodic surveys from specialized care centers (OPPIDUM; ‘Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse’), and community pharmacists (OSIAP; ‘Ordonnances Suspectes Indicateur d’Abus Possible’). Results: A total of 649 cases (75% men, median age: 34 years) were spontaneously reported: 578 cases of abuse and 71 cases of use as opiate maintenance treatment. The medication formulation was Skenan® (614 cases), and Moscontin® (35 cases). All surveys (NotS, OPPIDUM, and OSIAP) showed an overrepresentation of Skenan® (87.9–94.6% of cases) that was intravenously injected in 60.4–61.2% of the cases. Data analysis showed that patients abusing morphine sulfate have a long history of drug abuse and a history of polydrug use. Conclusion: All the data presented in this study highlight the level of morphine sulfate abuse, specify the modalities of use (intravenous route), and show the risks associated with abuse (infectious diseases). This study outlines the usefulness of our epidemiological tools, and provides evidence supporting intensive surveillance.

Substances Abuse and Mental Health Services Administration: Results from the 2008 National Survey on Drug Use and Health: National Findings. HHS Publication No. SMA 09–4434. Rockville, Substances Abuse and Mental Health Services Administration, Office of Applied Studies, 2009.
Casati A, Sedefov R, Pfeiffer-Gerschel T: Misuse of medicines in the European Union: a systematic review of the literature. Eur Addict Res 2012;18:228–245.
European Monitoring Centre for Drugs and Drug Addiction. Annual Report 2009.
Cicero TJ, Dart RC, Inciardi JA, Woody GE, Schnoll S, Muñoz A: The development of a comprehensive risk-management program for prescription opioid analgesics: researched abuse, diversion and addiction-related surveillance (RADARS). Pain Med 2007;8:157–170.
Baumevieille M, Daveluy A, Maurain C, Bégaud B, Haramburu F: Medicines submitted to narcotics regulations in France, 1992–2007. Fundam Clin Pharmacol 2009;23:345–349.
Montastruc JL, Arnaud P, Barbier C, Berlin I, Gatignol C, Haramburu F, Lagier G, Lapeyre-Mestre M, Mallaret M, Micaleff J: Critères pharmacologiques d’un médicament pour la substitution de la pharmacodépendance aux opiacés. Therapie 2003;58:123–125.
Jegu J, Gallini A, Soler P, Montastruc JL, Lapeyre-Mestre M: Slow-release oral morphine for opioid maintenance treatment: a systematic review. Br J Clin Pharmacol 2011;71:832–843.
Ministère de l’Emploi et de la Solidarité: Décret no. 99–249 du 31 Mars 1999 Relatif aux Substances Vénéneuses et à l’Organisation de la Pharmacodépendance, Modifiant le Code de la Santé Publique.
Baumevieille M, Miremont G, Haramburu F: Le système français d’évaluation de la pharmacodépendance et de l’abus: consécration juridique. Therapie 2001;56:15–22.
Gandilhon M, Cadet-Taïrou A, Toufik A, Evrard I: Opiacés, stimulants, hallucinogènes et médicaments détournés en 2005 dans des populations fortement consommatrices. Septième rapport national du dispositif TREND. Saint-Denis, OFDT. 2006. No. 52:3.
Micaleff J, Jolliet P, Victorri-Vigneau C, Mallaret M, Richard N, Haramburu F, Lapeyre-Mestre M: First meeting of the French CEIP (Centres d’Evaluation et d’Information sur la Pharmacodépendance). Assessment of the abuse and pharmacodependence potential during drug development. Therapie 2008;63:55–65.
Thirion X, Micallef J, Barrau K, Djezzar S, Sanmarco JL, Lagier G: Observation of psychoactive substance consumption: methods and results of the French OPPIDUM programme. Eur Addict Res 2001;7:32–36.
Frauger E, Nordmann S, Orleans V, Pradel V, Pauly V, Thirion X, Micallef J, réseau des CEIPs: Which psychoactive prescription drugs are illegally obtained and through which ways of acquisition? About OPPIDUM survey. Fundam Clin Pharmacol 2012;26:549–556.
Boeuf O, Lapeyre-Mestre M, French Network of Centers for Evaluation and Information Pharmacodependence (CEIP): Survey of forged prescriptions to investigate risk of psychoactive medications abuse in France: results of OSIAP survey. Drug Saf 2007;30:265–276.
Cadet-Taïrou A, Coquelin A, Toufik A: CAARUD: profils et pratiques des usagers en 2008. Observatoire Français des drogues et toxicomanie. Tendances 2010;74.
Costes JM: French monitoring centre for drugs and drug addiction. Key Data 2007.
Frauger E, Pauly V, Pradel V, Rouby F, Arditti J, Thirion X, Lapeyre Mestre M, Micallef J: Evidence of clonazepam abuse liability: results of the tools developed by the French Centers for Evaluation and Information on Pharmacodependence (CEIP) network. Fundam Clin Pharmacol 2011;25:633–641.
Jones JD, Mogali S, Comer SD: Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend 2012;125:8–18.
McCabe SE, West BT, Teter CJ, Boyd CJ: Co-ingestion of prescription opioids and other drugs among high school seniors: results from a national study. Drug Alcohol Depend 2012;126:65–70.
Serrano A, Parsons LH: Endocannabinoid influence in drug reinforcement, dependence and addiction-related behaviors. Pharmacol Ther 2011;132:215–241.
Surratt H, Kurtz SP, Cicero TJ: Alternate routes of administration and risk for HIV among prescription opioid abusers. J Addict Dis 2011;30:334–341.
Pauly V, Pradel V, Pourcel L, Nordmann S, Frauger E, Lapeyre-Mestre M, Micallef J, Thirion X: Estimated magnitude of diversion and abuse of opioids relative to benzodiazepines in France. Drug Alcohol Depend 2012;126:13–20.
Martin-Latry K, Bégaud B: Pharmacoepidemiological research using French reimbursement databases: yes we can! Pharmacoepidemiol Drug Saf 2010;19:256–265.
Drug Abuse Warning Network, 2009: Selected Tables of National Estimates of Drug-Related Emergency Department Visits. Rockville, Center for Behavioral Health Statistics and Quality, SAMHSA, 2010.
Walsh SL, Nuzzo PA, Lofwall MR, Holtman JR: The relative abuse liability of oral oxycodone, hydrocodone and hydromorphone assessed in prescription opioid abusers. Drug Alcohol Depend 2008;98:191–202.
Drug Abuse Warning Network, 2008: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. SMA 11–4618. Rockville, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2011.
Schneider MF, Bailey JE, Cicero TJ, Dart RC, Inciardi JA, Parrino M, Muñoz A: Integrating nine prescription opioid analgesics and/or four signal detection systems to summarize statewide prescription drug abuse in the United States in 2007. Pharmacoepidemiol Drug Saf 2009;18:778–790.
Butler SF, Budman SH, Licari A, Cassidy TA, Lioy K, Dickinson J, Brownstein JS, Benneyan JC, Green TC, Katz N: National addictions vigilance intervention and prevention program (NAVIPPRO): a real-time, product-specific, public health surveillance system for monitoring prescription drug abuse. Pharmacoepidemiol Drug Saf 2008;17:1142–1154.
Lobmaier P, Gossop M, Waal H, Bramness J: The pharmacological treatment of opioid addiction – a clinical perspective. Eur J Clin Pharmacol 2010;66:537–545.
Beer B, Rabl W, Libiseller K, Giacomuzzi S, Riemer Y, Pavlic M: Impact of slow-release oral morphine on drug abusing habits in Austria. Neuropsychiatr 2010;24:108–117.
Richard N, Arditti J, Pepin G, Mallaret M, Castot A: DRAMES (Death related to drug and illegal substance abuse): an identification tool of drug-related deaths in France. BEH 2010:40–41.
DRAMES (Décès en relation avec l’abus de médicaments et de substances). Résultats de l’enquête 2008. Afssaps. Centres d’Evaluation et d’Information sur la Pharmacodépendance (CEIP-Addictovigilance). Afssaps Saint-Denis, March 2010.
DRAMES: Résultats de l’enquête 2007. Afssaps. Centres d’Evaluation et d’Information sur la Pharmacodépendance (CEIP-Addictovigilance). Afssaps Saint-Denis, March 2009.
Commission Nationale des Stupéfiants et Psychotropes: 2009. Réunion, Agence Française de Sécurité Sanitaire des Produits de Santé, 2009.
Smith HS: Morphine sulfate and naltrexone hydrochloride extended release capsules for the management of chronic, moderate-to-severe pain, while reducing morphine-induced subjective effects upon tampering by crushing. Expert Opin Pharmacother 2011;12:1111–1125.
Raffa RB, Pergolizzi JV: Opioid formulations designed to resist/deter abuse. Drugs 2010;70:1657–1675.
Cicero TJ, Ellis MS, Surratt H: effect of abuse-deterrent formulation of Oxycontin. N Engl J Med 2012;367:187–189.
Victorri-Vigneau C, Dailly E, Veyrac G, Jolliet P: Evidence of zolpidem abuse and dependence: results of the French Centre for Evaluation and Information on Pharmacodependence (CEIP) network survey. Br J Clin Pharmacol 2007;64:198–209.
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