An Occupational Perspective on Psychedelic Therapy: A Scoping Review.

Background. Interest in the use of psychedelics for mental health therapy is burgeoning. Qualitative research methods are increasingly used to understand patient's experiences; however, there is a lack of literature that explores psychedelic use from an occupational perspective. Purpose. To conduct a scoping review of qualitative literature on the experiences of psychedelic use for the purpose of mental health therapy, through an occupational lens. Key Issues. Wilcock's occupational perspective of health was employed to analyze the use of psychedelics in mental health from an occupational perspective. Despite heterogeneous therapy contexts and substances used, patients reported comparable benefits regarding occupational engagement, such as increased mindfulness and autonomy in doing, a renewed sense of being, greater motivation to grow and become, and an improved sense of connection and belonging. Implications. This review demonstrates how psychedelic use in the context of mental health support can be experienced as a meaningful occupation and may contribute to overall health. In turn, this review highlights the utility of an occupational perspective for "non-sanctioned" or stigmatized occupations like psychedelic use, as well as the need for more research on psychedelic use from an occupational perspective. Using an occupational perspective of health can help to de-stigmatize psychedelic use as a meaningful occupation, rather than a deviant one, and shed light on how psychedelics may also positively impact one's participation in everyday life and overall health.

Association between substance use and professional outcomes among medical students: Findings from a Canadian cross-sectional survey.

Background: While substance use is common among medical students, there is limited research on this topic involving Canadian medical students or exploring its associations with professional outcomes. The present study examines the association between Canadian medical students' substance use and related counselling attitudes and practices, career satisfaction, academic/clinical workload, and the medical school environment. Methods: We sent an electronic cross-sectional survey to students attending all 17 Canadian medical schools between November 2015 and March 2016. A total of 4,438 participants completed the survey across four years of study, with a participation rate of 40.2%. We considered four categories of substance use: cannabis, alcohol, non-medical use of prescription stimulants (NPS), and cigarettes. Covariates included professional attitudes (e.g., career satisfaction, distress, patient counselling on alcohol or smoking cessation), specialty of interest, learner mistreatment, and perceived medical school support. We used multivariate logistic regression models, generating adjusted odds ratios (AORs), to examine covariates associated with substance use and how substance use (as a covariate) was associated with different professional outcomes. Results: Individuals more interested in "lifestyle" specialties (AOR, 1.81; 95% CI, 1.08-3.05) and surgical specialties (AOR, 1.69; 95% CI, 1.16-2.47) were more likely to report excessive alcohol use. Those interested in primary care were more likely to report cannabis use in the past 12 months (AOR, 1.85; 95% CI, 1.14-3.00). We did not identify significant associations between specialty of interest and current cigarette or NPS use in the past 12 months. However, excessive alcohol use was associated with greater career satisfaction (AOR, 1.24; 95% CI: 1.04-1.49), whereas NPS in the past 12 months was associated with poorer career satisfaction (AOR, 0.63; 95% CI: 0.42-0.93). In addition, there was a negative association between NPS use and the ability to handle workloads due to physical (AOR, 0.31; 95% CI, 0.18-0.54) or mental health issues (AOR, 0.46; 95% CI, 0.30-0.71), but not for other substances. We also found significant negative associations between current cigarette use and the perceived relevance of smoking cessation counselling (AOR, 0.48; 95% CI: 0.29-0.80) and alcohol cessation counselling (AOR, 0.42; 95% CI: 0.25-0.70). Conclusions: These findings suggest that specific patterns of substance use in medical students appeared to be significantly associated with some professional outcomes, specialty of interest, and attitudes towards addiction-related clinical practice. Encouraging medical students to practise healthy habits, including minimizing harmful substance use behaviours, could be an important target for improving medical students' health and their patient care.

Contexte: Bien que la consommation d'alcool et de drogues soit courante chez les étudiants en médecine, peu d'études sur ce sujet ont été menées auprès d'étudiants canadiens en médecine ou ont exploré ses liens avec les résultats professionnels. La présente étude examine l'association entre la consommation de substances psychoactives des étudiants canadiens en médecine et les comportements et habitudes en matière de suivi psychologique, la satisfaction à l'égard de la carrière, la charge de travail universitaire/en clinique et l'environnement de la faculté de médecine. Méthodes: Nous avons fait parvenir une enquête transversale électronique aux étudiants fréquentant les 17 facultés de médecine canadiennes entre novembre 2015 et mars 2016. Au total, 4 438 participants ont répondu à l'enquête sur quatre années d'études, avec un taux de participation de 40,2 %. Nous avons considéré quatre catégories de consommation de substances : le cannabis, l'alcool, l'utilisation non médicale de stimulants sur ordonnance (NSO) et les cigarettes. Les covariables comprenaient les attitudes professionnelles (par exemple, la satisfaction professionnelle, la détresse, les conseils aux patients sur l'arrêt de l'alcool ou du tabac), la spécialité choisie, les maltraitances infligées aux étudiants et le soutien perçu de la faculté de médecine. Nous avons utilisé des modèles de régression logistique multivariés, générant des rapports de cotes ajustés (RCA), pour examiner les covariables associées à la consommation de substances et la façon dont la consommation de substances (en tant que covariable) était associée à différents résultats professionnels. Résultats: Les personnes plus intéressées par les spécialités "mode de vie" (RCA, 1,81 ; IC 95 %, 1,08-3,05) et les spécialités chirurgicales (RCA, 1,69 ; IC 95 %, 1,16-2,47) étaient plus susceptibles de déclarer une consommation excessive d'alcool. Les personnes intéressées par les soins primaires étaient plus susceptibles de déclarer avoir consommé du cannabis au cours des 12 derniers mois (RCA, 1,85 ; IC à 95 %, 1,14-3,00). Nous n'avons pas identifié d'associations significatives entre la spécialité choisie et la consommation de cigarettes ou de NSO au cours des 12 derniers mois. Toutefois, la consommation excessive d'alcool était associée à une plus grande satisfaction professionnelle (RCA, 1,24 ; IC à 95 % : 1,04-1,49), tandis que la consommation de NSO au cours des 12 derniers mois était associé à une plus faible satisfaction professionnelle (RCA, 0,63 ; IC à 95 % : 0,42-0,93). En outre, il existe une association négative entre la consommation de NSO et la capacité à gérer la charge de travail en raison de problèmes de santé physique (RCA, 0,31 ; IC à 95%, 0,18-0,54) ou mentale (RCA, 0,46 ; IC à 95%, 0,30-0,71), mais pas pour les autres substances. Nous avons également constaté des associations négatives significatives entre l'usage de la cigarette et la pertinence perçue des conseils en matière d'arrêt du tabac (RCA, 0,48 ; IC 95 % : 0,29-0,80) et des conseils en matière d'arrêt de l'alcool (RCA, 0,42 ; IC 95 % : 0,25-0,70). Conclusions: Ces résultats suggèrent que des modèles spécifiques de consommation de substances psychoactives chez les étudiants en médecine semblent être significativement associés à certains résultats professionnels, à la spécialité choisie et aux attitudes envers la pratique clinique liée à la dépendance. Encourager les étudiants en médecine à adopter des habitudes saines, notamment en minimisant les comportements nocifs liés à la consommation de substances, pourrait être un objectif important pour améliorer la santé des étudiants en médecine et les soins aux patients. Motsclés: Consommation de substances psychoactives ; Étudiants en médecine ; Enquête ; Canada.

La protection des enfants et des adolescents contre les risques du vapotage.

Le vapotage chez les jeunes comporte des risques importants pour la santé et la sécurité des enfants et des adolescents canadiens. Le présent document de principes fournit de l'information générale sur le vapotage et les produits et dispositifs qui y sont liés, traite des méfaits à court et à long terme associés à leur utilisation et propose des stratégies de prévention et d'abandon pour les jeunes vapoteurs ou ceux qui sont à risque de commencer à vapoter. Le vapotage chez les jeunes est associé à un risque accru d'usage de tabac et de substances psychoactives, de troubles de santé mentale, de pneumopathie, de cardiopathie et de blessures accidentelles. Le vapotage ne doit pas servir d'outil d'abandon du tabac chez les jeunes, en raison de son manque d'efficacité et des données probantes sur les méfaits qu'il occasionne. De nombreuses stratégies préventives et thérapeutiques utilisées pour l'abandon du tabac, y compris les stratégies comportementales et pharmacologiques, peuvent être adaptées pour aider les jeunes à arrêter de vapoter. Des recommandations sont formulées pour les intervenants communautaires et les décideurs.

[Particularities of psychiatric and dermatological comorbidity among medical students in Morocco: Multicenter study]. / Particularités de la comorbidité psychiatrique et dermatologique chez les étudiants en médecine au Maroc : étude multicentrique.

OBJECTIVES: To evaluate the prevalence and factors associated with dermatological conditions and to study the peculiarities of comorbidity between psychiatric disorders and dermatological conditions among medical students in Morocco. METHODS: This is a multicenter, descriptive, and analytical cross-sectional study over a period of 4 weeks during the month of February 2019. RESULTS: Six hundred and five students from the seven faculties of medicine of Morocco were included. Dermatological conditions were present in 15.5% (94) of students, acne being the most common condition (10.7%), followed by psoriasis in 1.65% of students as well as urticaria in 1.65%. Psychiatric disorders were present in 28% (168) of the students depression being the most common disorder (10.4%), followed by anxiety disorders (7.8%), comorbidity between depression and anxiety disorder (6.94%), and psychotic disorders (2.46%). Dermatological diseases were significantly and independently associated with the presence of a psychiatric disorder (0.0000) and marital status (P=0.0103). Suicide attempts and substance use are more common among medical students who have an association between psychiatric disorder and dermatological pathology compared to students with isolated dermatological conditions or students with isolated psychiatric disorders. CONCLUSION: Dermatological and psychiatric conditions are frequent and underestimated among medical students in Morocco. Dermatologic and psychiatric comorbidity is associated with a higher prevalence of psychoactive substance use and suicide attempts.

Além da compulsão e da escolha: autonomia, temporalidade e recuperação pessoal / Beyond compulsion and choice: autonomy, temporality and personal recovery / Au-delà de la contrainte et du choix: autonomie, temporalité et rétablissement personnel / Mas allá de la compulsión y la elección: autonomía, temporalidad y recuperación

Este artigo discute a autonomia da pessoa que faz uso problemático de substâncias psicoativas (UPSP). Após o exame da ideia de autonomia de quem faz UPSP, a partir dos paradigmas médico, psicológico e moral, que oscilam entre as compreensões do uso como compulsão ou escolha, discute-se os aspectos psicopatológicos envolvidos no UPSP, em especial a experiência da temporalidade e suas implicações para o debate da autonomia dessas pessoas e para o seu processo de recuperação pessoal.

This paper discusses the autonomy of subjects engaged in substance misuse (SM). After examining the concept of autonomy of subjects engaged in SM, based on medical, psychological and moral paradigms that range between understanding SM either as a compulsion or a choice, we discuss the psychopathological aspects involved in SM, i.e., the experience of temporality and its implications regarding the autonomy of these subjects and their recovery process.

Cet article discute l'autonomie de personnes sujettes à l'utilisation problématique de substances psychoactives (UPSP). Après avoir élaboré la notion d'autonomie de ces sujets à partir de paradigmes médicaux, psychologiques et moraux qui comprennent l'UPSP soit comme une contrainte, soit comme un choix, on discute les aspects psychopathologiques liés à l'UPSP, en particulier l'expérience de la temporalité et ses implications pour le débat sur l'autonomie de ces personnes et leur processus de rétablissement.

Este artículo discute la autonomía de la persona que sufre con el consumo problemático de sustancias psicoactivas (CPSP). Después examinar la idea de autonomía en quien tiene un CPSP, a partir de los paradigmas médico, psicológico y moral, que oscilan entre las comprensiones del uso como compulsión o elección, se discuten los aspectos psicopatológicos involucrados en el CPSP, en especial en la experiencia de la temporalidad, y sus implicaciones para el debate de la autonomía de esas personas y para su proceso de recuperación personal.

Dieser Artikel ergründet die Autonomie von Personen, die einen problematischen Gebrauch von psychoaktiven Stoffen machen. Wir analysieren den Begriff der Autonomie dieser Subjekte basierend auf medizinischen, psychologischen und moralischen Paradigmen, die den Drogenkonsum entweder als Zwang oder Wahl verstehen. Nachfolgend diskutieren wir dann die psychopathologischen Aspekte des Drogenkonsums, vornehmlich die Erfahrung der Temporalität und ihren Einfluss auf die Debatte über die Autonomie dieser Subjekte während ihres Rehabilitationsprozesses.

[From psychoactive medicines to addictovigilance in French Public Health Code (1990-2017)]. / Du médicament psychoactif à l'addictovigilance dans le Code de la santé publique en France (1990­2017).

Addictovigilance in the French Public Health Code, in the section related to poisonous substances, refers to a monitoring system developed since 1990: control of psychoactive substances and products, with medicinal use or not, was completed by a specific system focused on evaluation and information on pharmacodependance in 1999. The French medicines agency (Agence du médicament) created in 1993 was involved in this monitoring system; pharmacodependance evaluation was added by law to the missions of the agencies that followed: the Agence française de sécurité sanitaire des produits de santé missions (AFSSAPS, 1998) and the Agence nationale de sécurité du médicament et des produits de santé (ANSM, 2011). "Addictovigilance" first appears in French Law in 2017 whereas it was used by pharmacodependance centers and AFSSAPS since 2007. Legal definition of addictovigilance in the French Public Health Code testified to public authorities action against addictive behavior whatever products status, legal or not. The visibility of addictovigilance is growing on the Internet as well (ANSM website, web portal for reporting adverse health events).

[Identification of abuse/dependence cases by the French addictovigilance network (FAN): A pilot study of the addictovigilance center and the psychotherapeutic center of Nancy (France)]. / Identification de cas d'abus/dépendance par le réseau français d'addictovigilance : une étude pilote du CEIP-A et du Centre psychothérapique de Nancy.

OBJECTIVES: France is the only European country with a dedicated addictovigilance network (French addictovigilance network [FAN]). However, the reporting of cases of abuse/dependence is insufficient. In an attempt to overcome this under-reporting, data from the medical information systems program (PMSI) is regularly used to identify cases. Since addictions are frequently associated with psychiatric comorbidities, a pilot study was conducted for the first time in a psychiatric hospital. It aims, through a PMSI request, to identify the sociodemographic characteristics and psychiatric diagnoses of patients consuming psychoactive substances (PAS) and the PAS types consumed. METHODS: This is a retrospective observational study conducted over a nine-month period at the psychotherapeutic center of Nancy (CPN). The codes used for the PMSI request are those of the international classification of diseases, tenth revision (ICD-10), codes F10 to F19 that characterize mental and behavioral disorders associated with the use of PAS. Cases presenting the four criteria necessary for an addictovigilance notification: (1) identified notifier, (2) identified patient, (3) known consumed product (s) and (4) presence of an effect related to the abuse/dependence of PAS; were retained and analyzed. RESULTS: On an initial number of 252 cases, 82 cases of abuse/dependence were retained. The selected sample is predominantly male (67%). Cannabis (29%) and heroin (15%) are the most common illicit PAS. Regarding drugs, the consumption of benzodiazepines, a predominantly female phenomenon, is observed in 34% of subjects. Sixty-four per cent of the subjects were diagnosed "disorders related to the use of PAS", 14% as neurotic disorders, 9% as schizophrenia and 5% as of the mood disorders. CONCLUSION: This study identified a significant number of potentially reportable cases to the French Addictovigilance Network and demonstrated the interest of investigating cases of abuse/dependence in a psychiatric hospital.

[Which psychiatric comorbidities in cannabis dependence during adolescence? Comparison of outpatients and controls]. / Quelles comorbidités psychiatriques dans la dépendance au cannabis à l'adolescence ? Comparaison de patients consultants et de témoins.

BACKGROUND: The use of illicit substances, in particular cannabis, among French adolescents and young adults has become an important public health concern. A better understanding of the mechanisms involved in pathological substance use is nowadays critical. Psychiatric comorbidities have been previously reported in adult substance abusers but are less documented in adolescents, especially regarding cannabis dependence. OBJECTIVES: We investigated mental health problems in adolescents and young adults, seeking treatment for their problematic cannabis use, comparatively to healthy controls, taking into account the participant's gender and age. Moreover, we explored the relationships between psychiatric diagnosis and substance use modalities. METHODS: In total, 100 young patients (80 males - mean age 18.2 (SD=2.9; [14 to 25] years old)) with a cannabis dependence (DSM-IV-TR criteria) seeking treatment in an addiction unit, and 82 healthy control subjects (50 males - mean age 18.3 (SD=3.4; [14 to 25] years old)) with no substance misuse diagnostic other than for alcohol, participated in the study. The MINI was administered to evaluate cannabis dependence, and DSM-IV axis I comorbid diagnosis, and a semi-structured interview was used to determine psychoactive substance use. RESULTS: Statistical analyses revealed that 79 % of the patients reported at least one other non-drug or alcohol comorbid diagnosis, versus 30.5 % in the control group (χ2=16.83; P<0.001). Logistic regression indicated that participants with a psychiatric diagnosis had an 8.6 times higher risk (P<0.001; OR 95 % CI=[4.38-16.81]) of being patients. Significant inter-group differences and OR were noted for several diagnoses: dysthymia over the previous 2years (χ2=14.06; P<0.001; OR=10.63; OR 95 % CI=[2.41-46.87]), life-time panic attack disorder (χ2=4.15; P<0.042; OR=3.59; OR 95 % CI=[0.98-13.19]), alcohol abuse (χ2=47.72; P<0.001; OR=66.27; OR 95 % CI=[8.87-495.11]) and dependence (V=0.230; P=0.001) and generalized anxiety disorder (χ2=7.46; P=0.006-OR=3.57; OR 95 % CI=[1.37-9.30]). On the whole, the females (n=20) of our clinical sample presented significantly more comorbid diagnoses than the males (n=80) (95 % versus 75 %; χ2=6.25, P=0.011). These significant gender differences were found for life-time eating disorder (V=0.352; P=0.007) and generalized anxiety disorder diagnoses (V=0.278; P=0.013). Moreover, young adult patients (19-25years old; n=35) presented, on the whole, significantly more comorbid diagnoses than adolescent patients (14-18years old; n=65) (70.8 % versus 94.3 %; χ2=7.58, P=0.006). These age inter-group differences were found for several diagnoses: alcohol dependence (6.2 % versus 20 %; V=0.211, P=0.047), dysthymia over the past 2years (13.8 % versus 34.3 %; χ2=5.73, P=0.017) and generalized anxiety disorder (12.3 % versus 40 %; χ2=10.17, P=0.001). Various associations were observed between psychiatric comorbid diagnosis and substance use indicators. CONCLUSION: This study demonstrates that cannabis dependence in adolescents and young adults is related to great psychological distress and puts emphasis on the importance of substance use prevention as early as middle school. Moreover, the psychiatric features of adolescents and young adults need to be taken into consideration for treatment planning.

Consumo de substâncias psicoativas por pacientes com tuberculose: interface entre a adesão ao tratamento e intervenção breve / Consumption of psychoactive substances in tuberculosis patients: interface to adherence to treatment and brief intervention

Introdução: o consumo de substâncias psicoativas associado à terapêutica da tuberculose (TB) estabelece uma urgente questão de saúde pública no mundo contemporâneo. O aumento da morbimortalidade, pertinente à incidência e prevalência da tuberculose, e o consumo indevido de substâncias psicoativas, tem refletido em resultados negativos, relacionados à saúde e questões sociais, para indivíduos e seus familiares (CASSIANO, 2014). Objetivos: identificar o perfil e o padrão de consumo de substâncias psicoativas por pacientes em tratamento da tuberculose, na Unidade de Atenção Primária à Saúde; analisar a adesão ao tratamento desses pacientes que fazem consumo de substâncias psicoativas e realizar a Intervenção Breve nessa clientela, na perspectiva da adesão ao tratamento da tuberculose. Método: estudo seccional, realizado em unidades de atenção primária à saúde, na modalidade da Estratégia Saúde da Família, na cidade do Rio de Janeiro, com 114 pacientes em tratamento da tuberculose, utilizando o questionário ASSIST. Foram incluídos na amostra todos os pacientes em tratamento de tuberculose. A variável de exposição foi o consumo de substâncias psicoativas, e a de desfecho, a adesão ao tratamento. Na primeira fase, realizou-se a Intervenção Breve, na etapa do feedback. Na segunda fase, após dois meses, foi realizada a busca no prontuário para confirmação ou não da adesão. Resultados: prevalência da população masculina 71,1%, idade mediana de 39 anos, escolaridade fundamental incompleta 52,6%, cor da pele parda 42,1%, renda familiar > 1 salário mínimo 74,5%, e vivia com familiares. Prevalência para tabaco 28,0%, bebidas alcoólicas 12,3%, maconha 5,4% e cocaína /crack 3,5%. Em relação à adesão, observou-se, após dois meses da Intervenção, em levantamento realizado nos prontuários dos pacientes, prevalência da população masculina, maiores de 40 anos, escolaridade médio/superior, casados e que viviam em união, brancos, recebiam até 1 salário mínimo, viviam com parentes; estes aderiram ao tratamento de tuberculose. Conclusão: esses resultados demonstram a importância da Intervenção Breve, realizada pelos profissionais de saúde com essa clientela, diminuindo a incidência de pacientes bacilíferos, propensos à disseminação da doença.

Introduction: The consumption of psychoactive substances associated with tuberculosis (TB) therapy establishes an urgent public health issue in the contemporary world. The increase in morbidity and mortality, pertinent to the incidence and prevalence of tuberculosis and the misuse of psychoactive substances, has reflected in negative results related to health and social issues for individuals and their families (CASSIANO, 2014). The objectives of this study were: To identify the profile and the pattern of consumption of psychoactive substances of patients undergoing tuberculosis treatment in the network of basic health services; to analyze the adherence to the treatment of patients of tuberculosis who consume these substances and perform brief intervention in this clientele from the perspective of the adherence to the tuberculosis treatment. Materials and Methods: Sectional study, carried out in primary care units in the modality of the Family Health Strategy, in the city of Rio de Janeiro, with n sample of 114 patients in the treatment of tuberculosis using the ASSIST questionnaire. All patients undergoing tuberculosis treatment were included in the sample. The exposure variable was the consumption of psychoactive substances and the outcome variable adherence to treatment. In the first phase the brief intervention was carried out, in the stages of feedback, due guidance and empathically. In the second phase after two months, a search was performed on the medical record for confirmation or non-compliance. Results: Prevalence in the male population71,1%, median age 39 years, incomplete primary schooling 52,6%, brown skin color 42,1%, family income > 1 minimum wage, 74,5% lived with relatives. Prevalence for tobacco 28,0%, alcoholic beverages 12,3%, marijuana 5,4% and cocaine / crack 3,5%. Regarding adherence, after two months of Brief Intervention, with a survey in the patients' charts, a higher prevalence of adherence was observed in the male population, over 40 years old, with medium / high school education, married and living in union, whites received up to 1 minimum wage, live with relatives, adhered to the treatment of tuberculosis. Conclusions: These results demonstrate the importance of brief interventions applied by health professionals with these patients, decreasing the incidence of bacilliferous patients, prone to the spread of the disease.

Introduction: la consommation de substances psychoactives associées au traitement de la tuberculose (TB) établit un problème urgent de santé publique dans le monde contemporain. L'augmentation de la morbidité et de la mortalité, qui est pertinente pour l'incidence et la prévalence de la tuberculose et l'abus de substances psychoactives, s'est traduite par des résultats négatifs liés aux problèmes de santé et sociaux pour les individus et leurs familles (CASSIANO,2014). Buts: identifier le profil y le schéma de consommation de substances psychoactives des patients en traitement contre la tuberculose, dans le Centre de Soins de Santé Primaires; analyser l'adhésion au traitement concernant ces patients qui font usage de substances psychoactives et réaliser une Intervention brève chez cette clientèle, dans le contexte de l'adhésion au traitement de la tuberculose. Méthode : étude sectionnelle, mise en marche dans des centres de Soins de Santé Primaires dans la modalité de la Stratégie sur la Santé de la Famille à Rio de janeiro, auprès de 114 patients en traitement contre la tuberculose, par le moyen du questionnaire ASSIST. Tous les patients en traitement contre la tuberculose y ont été inclus. La variable d'exposition fut la consommation de substances psychoactives et celle de résultat l'adhésion au traitement. Dans la première phase, une intervention brève a été mise en marche, à l'étape du feedback. Dans la deuxième phase, après deux mois, fur réalisée la recherche du dossier médical pour confirmer ou pas l'adhésion. Résultats: prévalence chez la population masculine - 71,1%, âge moyen - 39 ans, scolarité primaire incomplète - 52,6%, couleur de peau brune - 42,1%, revenu familial > 1 SMIC - 74,5% et habite avec la famille. Prévalence pour tabac - 28,0%, boissons alcoolisées - 12,3%, cannabis - 5,4% et cocaïne/crack - 3,5%. Concernant l'adhésion, après deux mois de l'Intervention, au moyen d'un relevé des dossiers médicaux des patients, on a observé une plus grande prévalence d'adhésion chez la population masculine, ayant plus de 40 ans, enseignement secondaire et universitaire, mariés en cohabitation, blancs, recevant jusqu'à un SMIC, ne vivant pas avec les familiers. Ceux-ci ont adhéré au traitement contre la tuberculose. Conclusion: ces résultats démontrent l'importance de l'Intervention brève mise en marche par les professionnels de la santé, auprès de cette clientèle, ce qui diminue l'incidence de patients frottis positif enclins à la dissémination de la maladie.

Introducción: el consumo de sustancias psicoactivas asociadas a la terapia contra la tuberculosis (TB) establece un problema urgente de salud pública en el mundo contemporáneo. El aumento de la morbilidad y mortalidad, pertinente a la incidencia y prevalencia de la tuberculosis y al uso indebido de sustancias psicoactivas, se ha reflejado en los resultados negativos relacionados con la salud y las cuestiones sociales de las personas y sus familiares (CASSIANO, 2014). Objetivos: identificar el perfil y el patrón de consumo de sustancias psicoactivas de los pacientes en tratamiento contra la tuberculosis, en el Centro de Atención Primaria de Salud; analizar la adhesión al tratamiento de esos pacientes que consumen sustancias psicoactivas y realizar Intervención Breve junto a esa clientela, en el contexto de la adhesión al tratamiento de la tuberculosis. Método: estudio seccional, realizado en centros de atención primaria en la modalidad de la Estrategia Salud de la Familia en la ciudad del Rio de janeiro, junto a 114 pacientes en tratamiento contra la tuberculosis, utilizando el cuestionario ASSIST. Se han incluido en el muestreo a todos los pacientes en tratamiento contra tuberculosis. La variable de exposición fue el consumo de sustancias psicoactivas y, la de resultado, adhesión al tratamiento. En la primera fase se realizó la Intervención Breve, en la etapa del feedback. En la segunda fase, después de dos meses, se realizó la búsqueda en la historia clínica para confirmar o no la adhesión. Resultados: prevalencia en la población masculina -71,1%, promedio de edad - 39 años, enseñanza primaria incompleta - 52,6%, color de piel pardo - 42,1%, ingresos familiares > 1 salario mínimo - 74,5% y viviendo con familiares. Prevalencia para tabaco - 28,0%, bebidas alcohólicas - 12,3%, marihuana -5,4% y cocaína /crack - 3,5%. Respecto a la adhesión, tras dos meses de la Intervención, con relevamiento en las historias clínicas de los pacientes, se observó mayor prevalencia en la adhesión en la población masculina, mayores de 40 años, con escolaridad secundaria/universitaria, casados y que vivían en unión estable, blancos, recibían hasta 1 salario mínimo, no vivían con parientes. Estos adhirieron al tratamiento de tuberculosis. Conclusión: esos resultados demuestran la importancia de la Intervención Breve realizada por los profesionales de salud, con esa clientela, disminuyendo la incidencia de pacientes bacilífero propensos a la diseminación de la enfermedad.

[Suicide, mental health and substance uses among French adolescents in 2014]. / Suicide, santé mentale et usages de substances psychoactives chez les adolescents français en 2014.

BACKGROUND: The aim of this study was to describe potential associations between suicidal behaviors and psychoactive substance uses among adolescents. METHODS: A cross-sectional, national survey representative of adolescents aged 17, living in continental France, was conducted in 2014. A total of 22,023 adolescents answered an anonymous, self-administered questionnaire about their health and their use of psychoactive substances. Suicidal risk was assessed by means of a 4-level indicator [1. No depression, as stipulated by the Adolescent Depression Rating Scale (ADRS); 2. Depression, no suicidal ideation, no suicidal attempts; 3. Depression with suicidal ideation; 4. Depression with suicidal attempts]. Multivariate logistic regressions were conducted to identify the factors significantly related to frequent substance uses. RESULTS: Three percent of adolescents (1.8% of boys vs. 3.7% of girls) were labeled as suffering from severe depression, 10% stated they had suicidal thoughts during the last year and 3% attempted to commit suicide at least once in their lifetime. The results support the view of a gradient between suicidal risk severity and regular use of tobacco and cannabis. The association with regular alcohol use appears somewhat weaker. CONCLUSION: Suicidal behaviors and regular substance uses are significantly related but also mediated by adolescents' mental health.

[Uro- and nephrotoxic effects of drugs of abuse: Literature review and pharmaco-epidemiological survey in France and in the Marseille area]. / Effets uro-néphrologiques des produits utilisés par les usagers de drogues : revue de la littérature et enquête pharmaco-épidémiologique en France et dans la région de Marseille.

A great diversification of drugs of abuse has been observed in recent years, both in the populations using them and in the types of drugs. Although dependency and psychiatric disorders associated with the abuse of these substances is well known, somatic complications, uro-nephrotoxicity in particular, are less recognized. We propose here an overview of the products used by drugs abusers in France, through the analysis of the national pharmaco-epidemiological study Observation des produits psychotropes illicites ou détournés de leur utilisation médicamenteuse (OPPIDUM). Among the 5003 patients who participated in this survey, 84% were on prescribed psychoactive substances, with indicators of abuse in 28% of cases; more than half of these patients had also been using drugs of abuse (mainly cannabis) in the previous week. We then describe the main urological and renal toxicities of these drugs, in particular of heroin, cocaine, cannabis, ecstasy, LSD, amphetamine, new designer drugs, ketamine and opiate substitution treatment. We finally present a pharmaco-epidemiological survey of patients hospitalized for drugs complications in nephrology at the university hospital of Marseille. Between 2000 and 2015, 22 patients aged 18 to 57 years were hospitalized for renal adverse effects of drugs of abuse, such as glomerulonephritides, focal segmental glomerulosclerosis, acute kidney injury or chronic kidney disease. The somatic complications of drugs participate in their dangerousness and should be a red flag. They should be systematically reported to the addictovigilance national network to allow the improvement of information given to the patients and the medical community, and to adapt the prevention and risk reduction policies.

Use of psychoactive substances in prison: Results of a study in the Lyon-Corbas prison, France.

BACKGROUND AND AIMS: In prison, in 2012, according to various sources, from 4 to 56% of the European inmate population used psychoactive substances (PAS). The aim of our study was to describe PAS consumption during incarceration in the prison of Lyon-Corbas, France. METHOD: A transversal descriptive study was conducted between September 23rd and September 27th 2013 among all inmates of this prison. We used an anonymous self-administered questionnaire, distributed at lunchtime and collected, the same day, at dinnertime, by the mental health service personnel. RESULTS: Among 785 inmates present at the time of the study in the prison of Lyon-Corbas, 710 were included and the response rate was 64.4% (95% CI [60.8-67.8]). Among 457 responding inmates, 16.4% (95% CI [13.2-20.0]) reported no PAS consumption. Among 382 consumers, 74.4% (95% CI [69.8-78.5]) used tobacco, 36.8% (95% CI [32.2-41.8]) cannabis, 30.4% (95% CI [25.9-35.1]) alcohol, 7.7% (95% CI [5.2-10.6]) heroin and 10.3% (95% CI [7.5-13.6]) cocaine. Furthermore, 15% of consumers had started PAS consumption during their incarceration. Among consumers of at least one PAS other than tobacco, cannabis and alcohol, the way of consumption was sniff for 60.0% (95% CI [48.5-70.2]) and injection for 31.0% (95% CI [21.6-42.1]). Use of several PAS at the same time and sharing sniffing and/or injection paraphernalia were other risky behaviors observed; 12% (95% CI [5.8-20.4]) of drug injectors declared using chlorine to sterilize their injection paraphernalia. CONCLUSION: Our study provides worrying data about PAS consumption in prison. The measures of prohibition do not prevent this consumption. There is even an initiation of consumption of PAS for 15% of the first-time incarcerated inmates. This finding should encourage public authorities to facilitate access of inmates to the care structures in prisons, to improve drug use prevention and care programs and to develop activities (sports, cultural, educational and vocational).

[Surveillance system on drug abuse: Interest of the French national OPPIDUM program of French addictovigilance network]. / Dispositif pharmacoépidémiologique de surveillance des substances psychoactives : intérêts du programme national OPPIDUM du Réseau français d'addictovigilance.

It is important to assess drug abuse liability in 'real life' using different surveillance systems. OPPIDUM ('Observation of illegal drugs and misuse of psychotropic medications') surveillance system anonymously collects information on drug abuse and dependence observed in patients recruited in specialized care centers dedicated to drug dependence. The aim of this article is to demonstrate the utility of OPPIDUM system using 2015 data. OPPIDUM is a cross-sectional survey repeated each year since 1995. In 2015, 5003 patients described the modality of use of 10,159 psychoactive drugs. Among them, 77% received an opiate maintenance treatment: 68% methadone (half of them consumed capsule form) and 27% buprenorphine (39% consumed generic form). Brand-name buprenorphine is more often injected than generic buprenorphine (10% vs. 2%) and among methadone consumers 7% of methadone capsule consumers have illegally obtained methadone (vs. 9% for syrup form). The proportion of medications among psychoactive drugs injected is important (42%), with morphine representing 21% of the total psychoactive drugs injected and buprenorphine, 16%. OPPIDUM highlighted emergent behaviors of abuse with some analgesic opioids (like tramadol, oxycodone or fentanyl), pregabalin, or quetiapine. OPPIDUM highlighted variations of drugs use regarding geographic approaches or by drug dependence care centers (like in harm reduction centers). OPPIDUM clearly demonstrated that collection of valid and useful data on drug abuse is possible, these data have an interest at regional, national and international levels.

[Characteristics of subjects under opiate maintenance treatment in primary care using the OPEMA data 2013]. / Caractéristiques des sujets sous traitement de substitution vus en médecine générale d'après l'enquête nationale OPEMA 2013.

AIM: The objective of the study is to describe the characteristics of subjects under opiate maintenance treatment by general practionners (GPs). METHOD: Data analysis from observatory for pharmacodependency in ambulatory medicine survey (observation des pharmacodépendances en médecine ambulatoire [OPEMA]) program in 2013 of the subjects under high dosage buprenorphine (HDB) and methadone prescribed or obtained illegally reported by GPs in France. RESULTS: Survey concerned consumers with 862, 433 and 429 of high dosage buprenorphine and respectively methadone. The average age is 39±9 years respectively, and 36±8 years; over 70% are male; 55% have paid employment and over 30% report social benefits; 9% are in temporary housing. In both groups, more than 50% have anxiety and depression; over 25% have associated somatic disorders and digestive diseases, respiratory, pain is the most common. Almost 99% use oral route; nearly 100% have a daily consumption and about 20% of the alcohol concomitantly; 24% of HDB use benzodiazepines and 18% of the methadone group (P=0.06); 33% of the population using methadone consume illicit psychoactive substances and 21% for HDB population (P<0.0001), in particular cannabis (P<0.0001). Heroin and cocaine are also consumed. CONCLUSION: The population consuming opiate maintenance treatments shows social, somatic and psychiatric vulnerability. Misuse associated forms and consumption of other psychoactive substances and illegal drugs are observed. Despite the complexity of management of these patients, general practitioners have a major role to play.

[Pregnancy and substance use in France: a literature review]. / Grossesse et usage de substances psychoactives en France. Synthèse de la littérature.

OBJECTIVES: Substance use during pregnancy is an important public health issue. It requires identifying at-risk populations and risk perception among women. MATERIALS AND METHODS: A literature review was conducted. It included French studies conducted since 2000 on substance use during pregnancy (tobacco, alcohol, marijuana, psychotropic drugs) and risk perception. RESULTS: In France, in 2010, 24% of pregnant women smoke--17% in the 3rd trimester. Depending on studies, the prevalence of alcohol use ranged from 12 to 63% and binge drinking ranged from 1 to 7%; daily drinking was below 0.5%. Marijuana use ranged from 1 to 3%, and psychotropic drugs ranged from 2 to 4%. Little research has been dedicated to risk perception. Studies show a lack of awareness about the equivalence of risks between fermented and distilled beverages and about the risks of moderate smoking during pregnancy. CONCLUSION: Data is lacking to characterize at-risk populations and mechanisms underlying risky behaviors.

[Self-esteem, coping, perceived social support and substance use in young adults with a cannabis dependence disorder]. / Estime de soi, coping, soutien social perçu et dépendance au cannabis chez l'adolescent et le jeune adulte.

INTRODUCTION: Self-esteem, coping strategies and perceived social support play a role in the adaptive functioning of the human being: they allow the adjustment of the subject to his/her environment. These dimensions could be protective factors regarding multiple risks associated with adolescent development, and particularly substance use. Thus our objective was twofold: to evaluate self-esteem, coping strategies and perceived social support in adolescents and young adults with a cannabis dependence in comparison with subjects from the general population; to establish the correspondence between these psychological dimensions and the patients' substance use pattern. METHOD: Data from 43 young patients (36 males; mean age=19.6±3), consulting for their cannabis dependence, and 50 young adults from the general population (39 males; mean age=19.7±3.4) were included. Participants completed the Rosenberg Self-Esteem Inventory, the Social Self-Esteem Inventory of Lawson, the Coping Inventory for Stressful Situation of Endler & Parker, and the Perceived Social Support Questionnaire of Sarason. The MINI was administered to evaluate cannabis abuse or dependence; a semi-structured clinical interview was given to determine psychoactive substance use. RESULTS: Between-group comparisons (two independent sample t-tests) showed that the patients had significantly lower scores on global (P=0.002) and social (P=0.035) self-esteem, task-oriented coping (P<0.001) and both availability and satisfaction regarding perceived social support (respectively P=0.029 and P<0.001). Conversely, patients had significantly higher scores on emotion-focused coping subscale (P=0.003). Logistic regressions showed that the satisfaction regarding social support and task-oriented coping scores were the more powerful to distinguish the patients from the controls (respectively ß=1.16, P=0.043 and ß=1.06, P=0.015). Unvaried linear regression analyses revealed a negative association between the age of first cannabis use and the avoidant-social coping score (P=0.025), and positive associations between the length of daily cannabis use and emotion-focused coping score (P=0.028), and frequency of cannabis use and global self-esteem scores (P=0.028). Moreover, polysubstance misuse is associated with low distraction-avoidant coping scores. No association was found between clinical scores and tobacco and alcohol uses variables. CONCLUSION: These results suggest that cannabis dependent patients may present a lack in individual and interpersonal resources. This clinical study underscores the potential contribution of maladaptive coping to the development or maintenance of substance use in young adulthood.

Crack: uma abordagem psicanalítica de seu consumo entre crianças e adolescentes em situação de rua / Crack: a psychoanalytic approach on its consumption among children and adolescents on the street / Crack: un enfoqueppsicoanalítico de su consumo entre los niños y adolescentes que viven en las calles / Crack: une approche psychanalytique de sa consommation chez les enfants et les adolescents vivant dans la rue

O objetivo geral deste artigo foi abordar o consumo de crack em crianças e adolescentes em situação de rua a partir do marco teórico da psicanálise. Delimitou-se como criança e adolescente em situação de rua, aquele que, com ou sem laço familiar, vive parte de seu tempo na rua sem a supervisão de um adulto que se responsabilize por ele. Foram isolados problemas decorrentes da situação de viver na rua - desnutrição, exploração do trabalho infantil, violência sexual, uso abusivo de drogas - e as modificações características da passagem da infância para a adolescência, que consolidam o acesso à vida adulta. Determinou-se, ao longo da argumentação teórica e dos dados empíricos obtidos a partir de pesquisa bibliográfica, que o desencadeamento do consumo de drogas, em especial o crack, na passagem da infância para a adolescência, se dá pelo processo de desvalorização social, de perda fálica associada ao lugar de resto, de refugo, que se instala na camada mais pobre da população brasileira, e que acaba por se transmitir para a criança. A partir dessas considerações, defendeu-se a hipótese de que o consumo abusivo de crack está diretamente associado à ausência de recursos subjetivos - promovidos pela baixa operatividade da função paterna - para lidar com as mudanças típicas desse tempo da constituição do sujeito.

This paper aims to address the crack consumption in children and adolescents on the street from the theoretical framework of psychoanalysis. It was delimited as children and adolescents living on the street, who, with or without family ties, living most of his time on the street without the supervision of an adult who is responsible for it. Were isolated problems arising from the situation of street life - malnutrition, child labor, sexual violence, drug abuse - and the changes characteristic of the passage from childhood to adolescence, which consolidate access to adulthood. It was determined along the theoretical arguments and empirical data that the onset of drug use, especially crack cocaine, in the passage from childhood to adolescence, is through the process of social devaluation, associated with the place of phallic loss furthermore, a place of human waste (outcasted, like garbage), which settles in the poorest population, which is finally transmitted to the child. From these considerations, defended the hypothesis that the abuse of crack is directly associated with absence of subjective resources - promoted by the low operability of the paternal function - to cope with the changes typical of this stage of the subjectivity development.

El objetivo de trabajo es abordar el consumo de crack en los niños y adolescentes en situación de calle desde el psicoanálisis teórico. El trabajo define a los niños y adolescentes en situación de calle, el que, con o sin lazos familiares, que viven la mayor parte de su tiempo en la calle sin la supervisión de un adulto responsable de él. El trabajo pone de relieve los problemas derivados de la situación de vida de la calle - la desnutrición, el trabajo infantil, la violencia sexual, el abuso de drogas - y los cambios de las características de la transición de la niñez a la adolescencia, que consolida el acceso a la vida adulta. El trabajo determinó a través de argumentos teóricos y datos empíricos que el desencadenamiento del consumo de drogas, especialmente el crack en la pasaje de la niñez a la adolescencia, es causada por el proceso de desvalorización social, pérdida fálica asociada con el lugar de refugo que se instala en los estratos más pobres de la población, lo que acaba transmitiendo a el niño. A partir de estas consideraciones, el trabajo defendió la hipótesis de que el consumo abusivo de crack está asociado directamente con la ausencia de los recursos subjetivos - promovido por la baja operatividad de la función paterna - para hacer frente a los cambios propios de esta etapa del desarrollo subjetivo.

Le but de cet article était de répondre à la consommation de crack chez les enfants et les adolescents en situation de rue à partir de la psychanalyse théorique. Le travail définit les enfants et les adolescents vivant dans la rue, qui, avec ou sans liens familiaux, vivant la plupart de leur temps dans la rue sans surveillance d'un adulte responsable. Le travail met en lumière les problèmes découlant de la situation de vie dans la rue - la malnutrition, travail des enfants, les violences sexuelles, la toxicomanie - et des changements dans les caractéristiques de la transition de l'enfance à l'adolescence, consolide l'accès à la vie adulte. Le travail déterminé par des arguments théoriques et empiriques que les médicaments desecadenamiento de consommation, en particulier fissure dans le passage de l'enfance à l'adolescence, est causée par le processus d'altération du fonctionnement social, la perte associée à lieu phallique qui refugo est installé dans les couches les plus pauvres de la population, qui vient de transmettre à l'enfant. A partir de ces considérations, le travail soutenu l'hypothèse selon laquelle l'abus de fissure est directement associée à l'absence de ressources subjectives - promu par la faible disponibilité de la fonction paternelle - pour faire face aux changements typiques de cette étape de développement subjective.

Crack: uma abordagem psicanalítica de seu consumo entre crianças e adolescentes em situação de rua / Crack: a psychoanalytic approach on its consumption among children and adolescents on the street / Crack: un enfoqueppsicoanalítico de su consumo entre los niños y adolescentes que viven en las calles / Crack: une approche psychanalytique de sa consommation chez les enfants et les adolescents vivant dans la rue

O objetivo geral deste artigo foi abordar o consumo de crack em crianças e adolescentes em situação de rua a partir do marco teórico da psicanálise. Delimitou-se como criança e adolescente em situação de rua, aquele que, com ou sem laço familiar, vive parte de seu tempo na rua sem a supervisão de um adulto que se responsabilize por ele. Foram isolados problemas decorrentes da situação de viver na rua - desnutrição, exploração do trabalho infantil, violência sexual, uso abusivo de drogas - e as modificações características da passagem da infância para a adolescência, que consolidam o acesso à vida adulta. Determinou-se, ao longo da argumentação teórica e dos dados empíricos obtidos a partir de pesquisa bibliográfica, que o desencadeamento do consumo de drogas, em especial o crack, na passagem da infância para a adolescência, se dá pelo processo de desvalorização social, de perda fálica associada ao lugar de resto, de refugo, que se instala na camada mais pobre da população brasileira, e que acaba por se transmitir para a criança. A partir dessas considerações, defendeu-se a hipótese de que o consumo abusivo de crack está diretamente associado à ausência de recursos subjetivos - promovidos pela baixa operatividade da função paterna - para lidar com as mudanças típicas desse tempo da constituição do sujeito.(AU)

This paper aims to address the crack consumption in children and adolescents on the street from the theoretical framework of psychoanalysis. It was delimited as children and adolescents living on the street, who, with or without family ties, living most of his time on the street without the supervision of an adult who is responsible for it. Were isolated problems arising from the situation of street life - malnutrition, child labor, sexual violence, drug abuse - and the changes characteristic of the passage from childhood to adolescence, which consolidate access to adulthood. It was determined along the theoretical arguments and empirical data that the onset of drug use, especially crack cocaine, in the passage from childhood to adolescence, is through the process of social devaluation, associated with the place of phallic loss furthermore, a place of human waste (outcasted, like garbage), which settles in the poorest population, which is finally transmitted to the child. From these considerations, defended the hypothesis that the abuse of crack is directly associated with absence of subjective resources - promoted by the low operability of the paternal function - to cope with the changes typical of this stage of the subjectivity development.(AU)

El objetivo de trabajo es abordar el consumo de crack en los niños y adolescentes en situación de calle desde el psicoanálisis teórico. El trabajo define a los niños y adolescentes en situación de calle, el que, con o sin lazos familiares, que viven la mayor parte de su tiempo en la calle sin la supervisión de un adulto responsable de él. El trabajo pone de relieve los problemas derivados de la situación de vida de la calle - la desnutrición, el trabajo infantil, la violencia sexual, el abuso de drogas - y los cambios de las características de la transición de la niñez a la adolescencia, que consolida el acceso a la vida adulta. El trabajo determinó a través de argumentos teóricos y datos empíricos que el desencadenamiento del consumo de drogas, especialmente el crack en la pasaje de la niñez a la adolescencia, es causada por el proceso de desvalorización social, pérdida fálica asociada con el lugar de refugo que se instala en los estratos más pobres de la población, lo que acaba transmitiendo a el niño. A partir de estas consideraciones, el trabajo defendió la hipótesis de que el consumo abusivo de crack está asociado directamente con la ausencia de los recursos subjetivos - promovido por la baja operatividad de la función paterna - para hacer frente a los cambios propios de esta etapa del desarrollo subjetivo.(AU)

Le but de cet article était de répondre à la consommation de crack chez les enfants et les adolescents en situation de rue à partir de la psychanalyse théorique. Le travail définit les enfants et les adolescents vivant dans la rue, qui, avec ou sans liens familiaux, vivant la plupart de leur temps dans la rue sans surveillance d'un adulte responsable. Le travail met en lumière les problèmes découlant de la situation de vie dans la rue - la malnutrition, travail des enfants, les violences sexuelles, la toxicomanie - et des changements dans les caractéristiques de la transition de l'enfance à l'adolescence, consolide l'accès à la vie adulte. Le travail déterminé par des arguments théoriques et empiriques que les médicaments desecadenamiento de consommation, en particulier fissure dans le passage de l'enfance à l'adolescence, est causée par le processus d'altération du fonctionnement social, la perte associée à lieu phallique qui refugo est installé dans les couches les plus pauvres de la population, qui vient de transmettre à l'enfant. A partir de ces considérations, le travail soutenu l'hypothèse selon laquelle l'abus de fissure est directement associée à l'absence de ressources subjectives - promu par la faible disponibilité de la fonction paternelle - pour faire face aux changements typiques de cette étape de développement subjective.(AU)

[Not Available]. / Abus et dépendances aux produits psychoactifs : étude de consommations à travers l'enquête OPPIDUM 2004 du réseau des CEIP.

The purpose of this study was to identify the characteristics of psychotropic drug use and abuse by drugs addicts. The results are based on data from OPPIDUM (Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse), an annual survey primarily concerned with the consumption of licit and illicit drugs. The study involved 3373 patients recruited during october 2004 from 109 health centers. The main trends observed were an increasing interest for opioid maintenance treatment by methadone versus buprenorphine high dosage (patients treated by methadone are mainly represented for the first year of the OPPIDUM program), some changes in illicit drugs uses (increase in sniff and decrease in intravenous injection) and changes in the grading of the most consumpted benzodiazepines (decrease in flunitrazepam consumption and increase in clonazepam consumption). Main warnings concern the buprenorphine illicit use leading to firstly dependence and the illicit use of some benzodiazepines, especially clonazepam.