Aim: To identify prescription drugs involved in falsified prescriptions in community pharmacies in 6 European countries. Methods: A cross-sectional survey among 2,105 community pharmacies in Belgium, France, Italy, the Netherlands, Spain and Sweden was carried out to collect all suspect prescription forms. For each reported drug, the number of reported falsified prescriptions per thousand inhabitants was estimated. A falsification ratio was calculated by dividing the number of reports by the number of defined daily doses per 1,000 inhabitants per day for this drug, computed from national sale or reimbursement data. Results: On 862 prescription forms, benzodiazepines (zolpidem, bromazepam, alprazolam), buprenorphine (as an opioid maintenance drug) and tramadol were the most frequently reported. Depending on their level of use in each country, methylphenidate, morphine and flunitrazepam presented the highest falsification ratios, particularly in Spain, Belgium and France. Conclusions: Stimulants, opioids and some benzodiazepines were the most frequently reported drugs in this survey on falsified prescriptions, but differences between countries were observed.

Keywords:
Prescription fraud, Abuse, Benzodiazepines, Methylphenidate, Opioids, Community pharmacies
1.
Hernandez SH, Nelson LS: Prescription drug abuse: insight into the epidemic. Clin Pharmacol Ther 2010;88:307-317.
2.
Griffiths P, Mounteney J, Lopez D, Zobel F, Gotz W: Addiction research centres and the nurturing of creativity. Monitoring the European drug situation: the ongoing challenge for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Addiction 2012;107:254-258.
3.
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.
4.
El-Aneed A, Alaghehbandan R, Gladney N, Collins K, Macdonald D, Fischer B: Prescription drug abuse and methods of diversion: the potential role of a pharmacy network. J Subst Use 2009;14:75-83.
5.
Barrett SP, Meisner JR, Stewart SH: What constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations. Curr Drug Abuse Rev 2008;1:255-262.
6.
Fischer B, Bibby M, Bouchard M: Non-medical use and diversion of psychotropic prescription drugs in North America: a review of sourcing routes and control measures. Addiction 2010;105:2062-2070.
7.
Frauger E, Nordmann S, Orleans V, Pradel V, Pauly V, Thirion X, Micallef J: Which psychoactive prescription drugs are illegally obtained and through which ways of acquisition? About OPPIDUM survey. Fundam Clin Pharmacol 2012;26:549-556.
8.
Bergman U, Griffiths RR: Relative abuse of diazepam and oxazepam: prescription forgeries and theft/loss reports in Sweden. Drug Alcohol Depend 1986;16:293-301.
9.
Bergman U, Dahl-Puustinen ML: Use of prescription forgeries in a drug abuse surveillance network. Eur J Clin Pharmacol 1989;36:621-623.
10.
Baumevieille M, Haramburu F, Begaud B: Abuse of prescription medicines in southwestern France. Ann Pharmacother 1997;31:847-850.
11.
Lapeyre-Mestre M, Damase-Michel C, Adams P, Michaud P, Montastruc JL: Falsified or forged medical prescriptions as an indicator of pharmacodependence: a pilot study. Eur J Clin Pharmacol 1997;52:37-39.
12.
Llau ME, Lapeyre-Mestre M, Plas L, Damase-Michel C, Montastruc JL: Forged medical prescriptions in a community pharmacy network in Midi-Pyrénées area: assessment of a falsification ratio. Eur J Clin Pharmacol 2002;57:911-912.
13.
Boeuf O, Lapeyre-Mestre M: Survey of forged prescriptions to investigate risk of psychoactive medications abuse in France: results of OSIAP survey. Drug Saf 2007;30:265-276.
14.
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.
15.
Peyriere H, Eiden C, Micallef J, Lapeyre-Mestre M, Faillie JL, Blayac JP: Slow-release oral morphine sulfate abuse: results of the postmarketing surveillance systems for psychoactive prescription drug abuse in France. Eur Addict Res 2013;19:235-244.
16.
OECD: Health at a Glance 2009: OECD Indicators. OECD Publishing, 2009. DOI: 10.1787/health_glance-2009-en.
17.
Buurma H, Bouvy ML, De Smet PA, Floor-Schreudering A, Leufkens HG, Egberts AC: Prevalence and determinants of pharmacy shopping behaviour. J Clin Pharm Ther 2008;33:17-23.
18.
Westerlund LT, Bjork HT: Pharmaceutical care in community pharmacies: practice and research in Sweden. Ann Pharmacother 2006;40:1162-1169.
19.
Rahimi B, Timpka T: Pharmacists' views on integrated electronic prescribing systems: associations between usefulness, pharmacological safety, and barriers to technology use. Eur J Clin Pharmacol 2011;67:179-184.
20.
Gugelmann HM, Perrone J: Can prescription drug monitoring programs help limit opioid abuse? JAMA 2011;306:2258-2259.
21.
Weill A, Paita M, Tuppin P, Fagot JP, Neumann A, Simon D, Ricordeau P, Montastruc JL, Allemand H: Benfluorex and valvular heart disease: a cohort study of a million people with diabetes mellitus. Pharmacoepidemiol Drug Saf 2010;19:1256-1262.
22.
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.
23.
Hajak G, Muller WE, Wittchen HU, Pittrow D, Kirch W: Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data. Addiction 2003;98:1371-1378.
24.
Pradel V, Delga C, Rouby F, Micallef J, Lapeyre-Mestre M: Assessment of abuse potential of benzodiazepines from a prescription database using ‘doctor shopping' as an indicator. CNS Drugs 2010;24:611-620.
25.
Baumevieille M, Daveluy A, Maurain C, Begaud B, Haramburu F: Medicines submitted to narcotics regulations in France, 1992-2007. Fundam Clin Pharmacol 2009;23:345-349.
26.
Griffiths RR, Johnson MW: Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds. J Clin Psychiatry 2005;66(suppl 9):31-41.
27.
Faccini M, Leone R, Pajusco B, Quaglio G, Casari R, Albiero A, Donati M, Lugoboni F: Lormetazepam addiction: data analysis from an Italian medical unit for addiction. Risk Manag Healthc Policy 2012;5:43-48.
28.
Frances C, Hoizey G, Millart H, Trenque T: Paediatric methylphenidate (Ritalin) restrictive conditions of prescription in France. Br J Clin Pharmacol 2004;57:115-116.
29.
Bruggisser M, Bodmer M, Liechti ME: Severe toxicity due to injected but not oral or nasal abuse of methylphenidate tablets. Swiss Med Wkly 2011;141:w13267.
30.
Frauger E, Pauly V, Natali F, Pradel V, Reggio P, Coudert H, Thirion X, Micallef J: Patterns of methylphenidate use and assessment of its abuse and diversion in two French administrative areas using a proxy of deviant behaviour determined from a reimbursement database: main trends from 2005 to 2008. CNS Drugs 2011;25:415-424.
31.
Gumy C, Huissoud T, Dubois-Arber F: Prevalence of methylphenidate prescription among school-aged children in a Swiss population: increase in the number of prescriptions in the Swiss canton of Vaud, from 2002 to 2005, and changes in patient demographics. J Atten Disord 2010;14:267-272.
32.
Treceno C, Martin Arias LH, Sainz M, Salado I, Garcia Ortega P, Velasco V, Jimeno N, Escudero A, Velasco A, Carvajal A: Trends in the consumption of attention deficit hyperactivity disorder medications in Castilla y León (Spain): changes in the consumption pattern following the introduction of extended release methylphenidate. Pharmacoepidemiol Drug Saf 2012;21:435-441.
33.
Lapeyre-Mestre M, Llau ME, Gony M, Navel AM, Bez J, Grau M, Montastruc JL: Opiate maintenance with buprenorphine in ambulatory care: a 24-week follow-up study of new users. Drug Alcohol Depend 2003;72:297-303.
34.
Pradel V, Thirion X, Ronfle E, Masut A, Micallef J, Begaud B: Assessment of doctor-shopping for high dosage buprenorphine maintenance treatment in a French region: development of a new method for prescription database. Pharmacoepidemiol Drug Saf 2004;13:473-481.
35.
Vidal-Trecan G, Varescon I, Nabet N, Boissonnas A: Intravenous use of prescribed sublingual buprenorphine tablets by drug users receiving maintenance therapy in France. Drug Alcohol Depend 2003;69:175-181.
36.
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.
37.
Cicero TJ, Adams EH, Geller A, Inciardi JA, Munoz A, Schnoll SH, Senay EC, Woody GE: A postmarketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States. Drug Alcohol Depend 1999;57:7-22.
38.
Cicero TJ, Inciardi JA, Adams EH, Geller A, Senay EC, Woody GE, Munoz A: Rates of abuse of tramadol remain unchanged with the introduction of new branded and generic products: results of an abuse monitoring system, 1994-2004. Pharmacoepidemiol Drug Saf 2005;14:851-859.
39.
Adams EH, Breiner S, Cicero TJ, Geller A, Inciardi JA, Schnoll SH, Senay EC, Woody GE: A comparison of the abuse liability of tramadol, NSAIDs, and hydrocodone in patients with chronic pain. J Pain Symptom Manage 2006;31:465-476.
40.
Tjaderborn M, Jonsson AK, Hagg S, Ahlner J: Fatal unintentional intoxications with tramadol during 1995-2005. Forensic Sci Int 2007;173:107-111.
41.
Tjaderborn M, Jonsson AK, Ahlner J, Hagg S: Tramadol dependence: a survey of spontaneously reported cases in Sweden. Pharmacoepidemiol Drug Saf 2009;18:1192-1198.
42.
Lakemedelsverkets (Medical Products Agency): Classification document. http://www.lakemedelsverket.se/malgrupp/Halso---sjukvard/Forskrivning/Narkotikaklassade-lakemedel/ (accessed December 4, 2013).
43.
Gaubert S, Vie M, Damase-Michel C, Pathak A, Montastruc JL: Dextropropoxyphene withdrawal from a French university hospital: impact on analgesic drug consumption. Fundam Clin Pharmacol 2009;23:247-252.
44.
Hamunen K, Paakkari P, Kalso E: Trends in opioid consumption in the Nordic countries 2002-2006. Eur J Pain 2009;13:954-962.
45.
Cherny NI, Baselga J, de Conno F, Radbruch L: Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: a report from the ESMO/EAPC Opioid Policy Initiative. Ann Oncol 2010;21:615-626.
46.
Compton WM, Volkow ND: Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug Alcohol Depend 2006;81:103-107.
47.
Ling W, Mooney L, Hillhouse M: Prescription opioid abuse, pain and addiction: clinical issues and implications. Drug Alcohol Rev 2011;30:300-305.
48.
Cicero TJ, Inciardi JA, Munoz A: Trends in abuse of oxycontin and other opioid analgesics in the United States: 2002-2004. J Pain 2005;6:662-672.
49.
Hamunen K, Laitinen-Parkkonen P, Paakkari P, Breivik H, Gordh T, Jensen NH, Kalso E: What do different databases tell about the use of opioids in seven European countries in 2002? Eur J Pain 2008;12:705-715.
50.
Ministère de la Santé: Décret no 2007-157 du 5 février 2007 relatif aux substances vénéneuses et modifiant le code de la santé publique. Journal Officiel de la République Française 07-02 2007, 0032, 0020.
51.
Schwan S, Sundstrom A, Stjernberg E, Hallberg E, Hallberg P: A signal for an abuse liability for pregabalin - results from the Swedish spontaneous adverse drug reaction reporting system. Eur J Clin Pharmacol 2010;66:947-953.
52.
Caster O, Edwards IR, Noren GN, Lindquist M: Earlier discovery of pregabalin's dependence potential might have been possible. Eur J Clin Pharmacol 2011;67:319-320.
53.
Pauly V, Frauger E, Pradel V, Nordmann S, Pourcel L, Natali F, Sciortino V, Lapeyre-Mestre M, Micallef J, Thirion X: Monitoring of benzodiazepine diversion using a multi-indicator approach. Int Clin Psychopharmacol 2011;26:268-277.
54.
Agence Nationale de Sécurité du Médicament et des Produits de Santé: état des lieux de la consommation des benzodiazépines en France, 2012. http://www.ansm.sante.fr/var/ansm_site/storage/original/application/3f1dc4756b5bc091879c9c254d95e05c.pdf (accessed December 4, 2013).
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.