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Crise Des Opioides Gestion D Une Pandemie

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Crise Des Opioides Gestion D Une Pandemie http://portaildoc.univ-lyon1.fr Creative commons : Paternité - Pas d’Utilisation Commerciale - Pas de Modification 2.0 France (CC BY-NC-ND 2.0) http://creativecommons.org/licenses/by-nc-nd/2.0/fr STEICHEN (CC BY-NC-ND 2.0) UNIVERSITE CLAUDE BERNARD - LYON 1 FACULTE DE PHARMACIE INSTITUT DES SCIENCES PHARMACEUTIQUES ET BIOLOGIQUES THESE n° 164 T H E S E Pour le DIPLOME D'ETAT DE DOCTEUR EN PHARMACIE Présentée et soutenue publiquement le 31 Octobre 2019 par Mme STEICHEN Marine Née le 06/01/1994 A Pertuis (84) ***** Crise des opioïdes : gestion d’une pandémie ***** JURY Mme SIRANYAN Valérie, Professeur M. BOURGUIGNON Laurent, Maître de Conférences-Praticien hospitalier Mme CINTRAT Maud, Maître de Conférences Mme LOUPIAC Eléonore, Docteur en Pharmacie STEICHEN (CC BY-NC-ND 2.0) 1 STEICHEN (CC BY-NC-ND 2.0) 2 STEICHEN (CC BY-NC-ND 2.0) 3 STEICHEN (CC BY-NC-ND 2.0) 4 STEICHEN (CC BY-NC-ND 2.0) 5 STEICHEN (CC BY-NC-ND 2.0) 6 STEICHEN (CC BY-NC-ND 2.0) 7 STEICHEN (CC BY-NC-ND 2.0) Remerciements A madame Valérie Siranyan, merci d’avoir accepté de présider ce jury et diriger ce travail. A monsieur Laurent Bourguignon et madame Maud Cintrat, merci d’avoir accepté de faire partie de ce jury. A madame Eléonore Loupiac, la parisienne la plus épanouie que je connaisse, merci d’avoir accepté d’être membre de ce jury. Merci pour ton soutien durant tout ce travail, pour tous tes conseils et merci pour toutes ces belles années d’études que l’on clôture ensemble de la plus belle des manières. Merci pour tous nos souvenirs qui soudent notre amitié pour la vie. A Brune, ma Bruda, à nos fins de soirées tardives, nos déclarations d’amour, merci pour ces souvenirs magiques qui quoi qu’il arrive resteront dans mon cœur. A Pauline, pour nos treks tronqués et nos délires que nous sommes les seules à comprendre. A la team des Bisounours, Laurie, Manon, Maëva, Axelle, Alix, Maxime, Héloïse, Lisa, Tressy et Nico mon co-ronéo boy préféré, merci pour tous ces jolis souvenirs qui resteront parmi les meilleurs. A Claire, à nos soirées infusion et nos promenades au bord des quais. A mes petites sœurs chéries, Elisa et Juliette, qui m’en font voir de toutes les couleurs mais que j’aime jusqu’à la lune. A mes parents que j’aime, grâce à qui j’en suis là aujourd’hui, merci de m’avoir permise de devenir celle que je suis. A Papou et Babou qui m’ont partagé leur amour pour la pharmacie depuis ma plus tendre enfance et m’en ont finalement donné le goût. A mes grands-parents. A toi, Jean-Marie, ma plus belle rencontre, merci pour ton aide précieuse et ta patience à toute épreuve au cours de ce travail. Merci de rendre ma vie plus douce, je t’aime… 8 STEICHEN (CC BY-NC-ND 2.0) 9 STEICHEN (CC BY-NC-ND 2.0) Table des matières Table des tableaux .......................................................................................................... 12 Tables des figures ........................................................................................................... 13 Liste des abréviations ...................................................................................................... 14 Introduction .................................................................................................................... 16 Partie I : Bon usage des médicaments opiacés et gestion des risques .......................... 18 I.1 Lutte contre la douleur .............................................................................................. 19 I.1.1 Histoire de la lutte contre la douleur ............................................................... 19 I.1.1.1 Le pavot à opium .......................................................................................... 20 I.1.1.2 L’opium médicinal ........................................................................................ 21 I.1.1.3 Le commerce de l’opium .............................................................................. 24 I.1.1.4 Du pavot à opium à la morphine ................................................................... 26 I.1.1.5 Le XXème siècle et les opiacés ....................................................................... 28 I.1.2 Physiologie de la douleur .................................................................................. 32 I.1.2.1 Définition de la douleur ................................................................................ 32 I.1.2.2 Les différentes formes de douleur ................................................................. 33 I.1.2.3 Mécanisme physiopathologique de la douleur .............................................. 37 I.1.2.4 Evaluation de la douleur ............................................................................... 46 I.1.3 Les médicaments contre la douleur ................................................................. 50 I.1.3.1 Le mécanisme d’action des antalgiques opiacés ........................................... 50 I.1.3.2 Pharmacologie, classification des antalgiques .............................................. 56 I.1.3.3 Recommandations de bonnes pratiques ........................................................ 67 I.1.3.4 La législation des opiacés ............................................................................. 67 I.2 De la douleur à la dépendance ................................................................................. 76 I.2.1 La dépendance : ................................................................................................. 76 I.2.1.1 Définitions : .................................................................................................. 76 I.2.1.2 Différentes situations de dépendance : ......................................................... 77 I.2.1.3 Facteurs de vulnérabilité : ............................................................................. 80 I.2.1.4 Les critères diagnostics de l’addiction: ......................................................... 83 I.2.1.5 Epidémiologie ............................................................................................... 87 I.2.2 Le syndrome de sevrage .................................................................................... 87 I.2.2.1 Définition ...................................................................................................... 87 I.2.2.2 Les risques de dépendance ............................................................................ 88 I.2.3. Hyperalgésie induite par les opioïdes ............................................................. 93 I.3 Les Traitements de Substitution aux Opiacés (TSO) ............................................... 95 I.3.1. La Méthadone ................................................................................................... 96 I.3.1.1. Caractéristiques ............................................................................................ 96 I.3.1.2. Indication ..................................................................................................... 97 I.3.1.3. Posologie ...................................................................................................... 97 10 STEICHEN (CC BY-NC-ND 2.0) I.3.1.4. Législation .................................................................................................... 98 I.3.2. La Buprénorphine ............................................................................................ 98 I.3.2.1. Caractéristiques ............................................................................................ 98 I.3.2.2. Indication ..................................................................................................... 99 I.3.2.3. Posologie ...................................................................................................... 99 I.3.2.4. Législation .................................................................................................. 100 I.3.3. La prise en charge .......................................................................................... 103 I.3.3.1 Les structures de prise en charge, organisation des soins ........................... 104 I.3.4. Surveillance et prévention des risques .......................................................... 106 I.3.4.1. Tests urinaires ............................................................................................ 106 I.3.4.2. Prévention des risques liés à la dépendance............................................... 107 Partie II : La crise des opioïdes en Europe et en Amérique du Nord ......................... 110 II.1. Pandémies ............................................................................................................. 112 II.1.1. Etat des lieux aux États-Unis ....................................................................... 113 II.1.1.1. Historique ................................................................................................. 113 II.1.1.2. Epidémiologie ........................................................................................... 116 II.1.2. Etat des lieux en France, vers une crise des opioïdes ? ............................. 122 II.1.2.1. Historique (43) .......................................................................................... 122 II.1.2.2. Epidémiologie ........................................................................................... 123 II.2. Solutions proposées .............................................................................................. 132 II.2.1. Surveillance sanitaire aux Etats-Unis ........................................................
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