Identification of drug misuse - Study of spontaneous notifications of adverse drug events in a regional safety reporting centre

Introduction The misuse of drugs, common practice for some, is a source of iatrogenic diseases and considerable supplementary costs in hospital budgets. The aim of this study was to quantify the number of adverse events (AE) related to the misuse of drugs. Methods This was a study conducted on 200 new validated AE case reports. In each report, we searched for the drug(s) responsible and checked whether the prescription respected the SPC (summary of product characteristics) and current guidelines or not. Results Among the 200 reports, 49 (24.5%) cases of AE were related to the misuse of a drug in 46 patients, with a mean age of 65.8 years [24 to 97]. Among these cases, 33 (67.3%) were at the origin of hospitalisation or prolongation of the latter. In 17 cases (34.7%), there was no therapeutic alternative to the drug used in the framework of misuse. Discussion The notion of good or bad use of a drug progresses with the life of the drug. We therefore selected as criterion of misuse the non-respect of the SCP but also other guidelines. Regarding the cases that could have been avoided, these concerned an AE related to poor surveillance and assessment of the benefit/risk ratio of treatments prescribed to elderly patients and also the commonplace use of non-steroidal anti-inflammatories, at the origin of digestive haemorrhages. Conclusion The prevention of misuse implies all the actors of the health system. A reassessment of the prescription of certain therapeutic classes of drugs would avoid a great number of iatrogenic accidents and would lead to considerable economy in the field of health. (C) 2003, Masson, Paris.