PARIS — Before her book published last month, Juliette Boudre says she knew little of other families struggling with addiction. Her book, ” Mom, Don’t Let Me Fall Asleep,” recounts how her son’s descent into drug abuse led to his death in 2016.
Boudre now says she receives dozens of emails a day from others across France whose children or family members are suffering from addiction or who died of an overdose. Boudre says most media attention on opioids, a subject rarely discussed in France, focuses on the crisis in the United States.
“They never talk about what’s happening in France,” Boudre says. “There’s fear and shame, and people feel very alone. People need help, and there isn’t enough.”
Boudre’s concerns are well founded. The number of people across France who annually die from opioid overdose is a fraction of the number in the U.S. But in recent years deaths in the country from opioid abuse have risen considerably, stirring new public concern here.
“There is a risk of an epidemic in France, but we’re still in a situation where we can avoid it,” says Nicolas Authier, a psychiatrist with SOS Addictions who specializes in pharmacology and addiction and is the director of the French Observatory of Analgesic Drugs (OFMA). “We have unfortunately benefited from the North American opioid crisis and are even more vigilant about prescriptions and proper use.”
In the U.S., 42,249 people died in 2016 from opioid overdoses from a population of 323 million, according to the U.S. Department of Health and Human Services. Nearly half of those deaths involved synthetic opioids, mostly fentanyls — a rate that increased nearly sevenfold, from 3,000 to more than 20,000, in just three years.
By comparison, 349 people in France died of overdoses in 2016, according to a report by the European Monitoring Center for Drugs and Addiction (EDMCCA) among a population of 66 million people — a number that rose threefold in the previous decade, according to OFMA. However, the number of opioid deaths may be underestimated, says the EMCDDA. When doctors fill out the death certificates, they may not always check the box for drug overdose.
“In some cases, it’s under pressure from the family to avoid a forensic procedure involving an autopsy. The family can also lobby for not being notified of drug use on the death certificate,” says Dr. Anne-Claire Brisacier, a public health physician in charge of studies at the French Observatory of Drugs and Addiction ( OFDT).
There are other troubling signals. Between 2004 and 2015, strong opioid use in France increased by 74 percent, and oxycodone use jumped by 1,550 percent, OFMA says. An April 2018 report by the British Pharmaceutical Society linked the increase in oxycodone prescriptions in part to pharmaceutical marketing practices and found that transmucosal fentanyl prescriptions increased 263 percent.
This April, the French National Agency for the Safety of Medicines and Health Products (ANSM). held a special two-day session to examine the use and abuse of opioid medications for pain relief in France.
“The situation isn’t comparable to the U.S., but we have seen an increase in misuse of these drugs. We’re trying to be cautious,” says Nathalie Richard, the agency’s deputy director for analgesics, narcotics and addiction drugs.
Misuse became personal for Boudre, whose son Joseph became addicted to benzodiazepines in middle school after they were prescribed for sleep troubles. At 16, he began buying the weak opiate codeine over the counter to get high. He spent much of his middle school and high school years in and out of rehab, trying to get clean.
“Opioids made the situation worse because they’re much stronger. They’re the next step,” Boudre says. “He wanted to stop, but it took over his body.” A mix of benzodiazepines and fentanyl, which Joseph bought on the street believing it was morphine, killed him.
Fentanyl is 100 times stronger than morphine, highly addictive, and doesn’t ease pain once a patient becomes dependent, Authier explains. It isn’t meant for long-term use and is medically reserved for cancer patients. For chronic pain, both fentanyl and oxycodone are intended as last-resort treatments.
“When we prescribe these medications too quickly, all other treatments seem ineffective in comparison,” Authier says. “With fentanyl in France, most of the problems are with patients who don’t have cancer. So (French doctors) aren’t always respecting the proper terms of prescription.”
It wouldn’t be the first time the French medical establishment has been accused of misprescribing. In 2011, the ANSM put 77 drugs with “undesirable side effects” under “reinforced surveillance” after a French drugmaker was taken to court for marketing a diabetes drug linked to heart disease, Mediator, as an appetite suppressant. President Nicolas Sarkozy commissioned two French doctors to write a report on the scandal, and the pair published a book claiming that half of all drugs prescribed in France were useless or potentially dangerous for patients.
Many observers say the opioid abuse crisis in the U.S. can be traced to 2000, when Congress passed the Pain Relief Promotion Act of 2000, which made treating chronic pain a priority. French authorities preceded the U.S. with a similar law in 1994 that counseled doctors to take pain treatment more seriously. Three national programs addressing pain relief followed over the next 16 years, expanding the prescription of opioids to treat conditions other than cancer and ensuring they were reimbursed by the French national healthcare system.
Today, France is still far from experiencing its own opioid crisis, which local health authorities attribute to several factors. The ANSM says prescriptions in France are highly regulated and monitored: Opioid prescriptions are limited to 28 days, and French doctors have been generally nervous about prescribing opiates, the agency says. Labs also aren’t allowed to market drug ads directly to consumers.
“In the United States, pharmaceutical companies have enjoyed infinitely greater freedom than in France, but also in Europe in general, to push for the sale of these drugs,” says Dr. Agnès Cadet-Taïrou of the OFDT.
The ANSM is educating doctors and patients about the risks of opioids in France, with a network of observatories throughout the country monitoring use. “It’s important to validate and repeat information. It seems simple, but we often have the most trouble with communication,” Authier says.
Naloxone, the drug that blocks opioid overdoses, is regularly distributed to high-risk users. A safe drug consumption room, Gaia, opened in Paris in 2016 and serves about 200 drug addicts every day with free needles and a safe space to shoot up — most often crack or Skenan, a strong prescription opioid sold on the streets — while offering access to optional counseling from social workers, psychiatrists and other health authorities.
“Since it opened, there’s much less public usage. You find fewer needles on the street than before. Thanks to Gaia, people discover they have the right to allocations and can express the beginning of their wish to change,” says Stephane Bribard, the deputy mayor for Paris’ 10th arrondissement.
In July 2017, a new French law made prescriptions for codeine mandatory after two teenagers died from “purple drank,” a mix of codeine cough syrup, antihistamine and soda. Authier says it’s too early to determine the outcome of this measure, although the ANSM’s Richard says they haven’t seen a notable increase in street drugs.
Authier says French authorities are creating a system to monitor social networks.
Even if such measures prevent opioid use from reaching crisis levels in France, Authier says the country is still left with the problem of easing chronic pain. “Unfortunately, there’s very little therapeutic innovation for pain relief.”
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Rise In Opioid Deaths in France Stirs New Alarm originally appeared on usnews.com
