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Assessment of Benzodiazepines Dependence in Patients During Research & Reviews: Journal of Hospital and Clinical Pharmacy Assessment of Benzodiazepines Dependence in Patients During Dispensing at Neighbourhood Pharmacies in Cote d’Ivoire Abrogoua DP1,2*, Vaubou F1, Brou NA1 and Doffou E3 1Department of Pharmaceutical and Biological Sciences, Therapeutic and Clinical Pharmacy Laboratory, University Felix Houphouet Boigny, Abidjan, Ivory Coast 2Clinical Pharmacology Department, Teaching Hospital of Cocody, Abidjan, Ivory Coast 3Pharmacy Department, Teaching Hospital of Yopougon, Abidjan, Ivory Coast Research Article Received date: 08/10/2016 ABSTRACT Accepted date: 12/12/2016 Objective: To identify the dispensing modes of benzodiazepines Published date: 20/12/2016 (BZD) and the level of dependence of patients to these drugs in the context of neighbourhood pharmacies. *For Correspondence Methods: We carried out an observational study from December 2014 to August 2015 on the dispensing of BZD in 10 neighbourhood Abrogoua DP, Faculty of Pharmaceutical and pharmacies selected randomly on the basis of one pharmacy in Biological Sciences, Therapeutic and clinical each district of Abidjan (Cote d’Ivoire). The survey was conducted Pharmacy Laboratory, University Felix Houphouet with consenting patients whatever the mode of dispensing: medical Boigny, Abidjan, Ivory Coast, Tel: 0022507949478. prescription (MP), spontaneous demand (SD) or pharmaceutical council (PC). The Cognitive scale for benzodiazepine attachment (ECAB scale) E-mail: [email protected] was used with patients. An ECAB score ≥ 6 helps identify dependent patients. Keywords: Benzodiazepines, Dispensing, Dependence, Neighbourhood pharmacies, Cote Results: A total of 298 patients were enrolled; dependence was d’Ivoire. assessed in 94.63% of them. The sex ratio was 1.5 males per female; the average age was 44.2 ± 14.2 years. Alcohol consumption was mentioned by 44.3% of patients. The dispensing of BZD was done by MP (61.4%), SD (34.9%) and PC (3.7%). The regulatory compliance of prescriptions was 54.6%. The most dispensed BZD were bromazepam (42.3%) and clonazepam (22.5%). A use of BZD ≥ 3 months concerned 40.6% of patients. An ECAB score ≥ 6 was found in 47.9% of patients. A duration of use of BZD>3 months was associated with a 25 times higher probability of being dependent (ECAB score ≥ 6). Conclusion: Pharmaceutical interventions should allow prevention, screening or management of BZD dependence. An optimal pharmaceutical follow-up must be exercised in neighbourhood pharmacies: an interview with the patient, the taking into account of the regulatory compliance of prescriptions, compliance with the rules for BZD delivery, respect of the limits of pharmaceutical medication with BZD, advice of respect of adherence and management of dependent patients. INTRODUCTION The pharmacist represents a vital link in the therapeutic process of management of inpatients and outpatients. Specifically, the pharmacist remains a local health professional, ensuring a constant presence and whose access is unrestricted. He is therefore a privileged interlocutor of the health system and a gateway in the course of care [1]. He plays a fundamental role in this course, especially in prevention and plays a real role of sentinel in public health. He also allows for regular monitoring of patients that he often sees for the dispensing of medicines. He is then a privileged channel for reporting information on adverse effects of treatment, as well as questions that may arise during the management of patients [2]. Pharmaceutical interventions can enable the prevention or detection of drug dependence, including benzodiazepines (BZD). J Hosp Clin Pharm| Volume 2 | Issue 4 | December 2016 14 Research & Reviews: Journal of Hospital and Clinical Pharmacy BZD are ambivalent molecules; effective on the one hand with a psychotropic effect that acts in the first minutes following the taking, but whose use can become a source of significant side effects and dependence[3] . However, over consumption of BZD is a reality world-wide. Lagnaoui et al. reported that 7.5% of the study population was regular consumers of BZD and over three quarters of them were chronic users [4]. Bourin presented in his study a prevalence rate of 3% of continuous use of BZD in the general population between 18 and 80 years [5]. Other studies have estimated that BZD accounted for 38% of hypnotic prescriptions in the United States [6-8]. The study "Epidemiology of Vascular Aging" (EVA), on a sample of 1265 elderly subjects (60-70 years) reported that the use of BZD was found in 23% of participants [9]. In Switzerland, Petitjean et al. reported in the retrospective analysis of the database of the community pharmacy distribution that 45,309 patients (9.1%) received at least one prescription of BZD within 6 months. These patients received a total of 128,725 prescriptions of BZD [10]. According to Pelissolo et al. 25% to 30% of adults have already consumed a psychotropic anxiolytic/hypnotic drug in the French general population [11]. In 2002/2003, a study named ESEMeD (European Study of the Epidemiology of Mental Disorders) was conducted in several European countries with more than 20,000 adults. This study showed that 12% of respondents had used at least one psychotropic drug during the previous year. Among these 12%, 9.8% were consumers of anxiolytics [12]. In many African countries, the non-therapeutic use of drugs subject to medical prescription, such as BZD, is still a source of considerable problems. The misuse of prescribed psychoactive substances is common [13]. Many BZD (zolpidem, bromazepam, alprazolam, clonazepam and zopiclone) are among the most found on suspect falsified medication orders presented to pharmacists (OSIAP investigation 2011) [14]. In Cote d’Ivoire, one study revealed the consumption of BZD in 34% of individuals with a urine test. The simultaneous detection of at least two drugs in the same urine sample involved 21 patients. The psychoactive substances most often found were cannabis and BZD; the most frequent associations involved the BZD [15]. The use of BZD causes problems of tolerance, dependence, effects on cognitive functions such as impairment of memory, concentration, without omitting to mention the abuse involving the taking of these molecules [16]. The prevalence of dependence in the general adult population is between 0.5 and 1% [17]. According to Cloos et al. 5% of the consumer population of BZD would be subject of high dose dependence, accounting for 1% of the general population [18]. The assessment of this dependence is difficult because if we refer to the definitions of the DSM-IV, we have dependence criteria for psychoactive substances in general and not specifically to the BZD. In addition, there are multiple addiction screening scales. These scales do not allow making a medical diagnosis but are useful for rapid screening. We can mention CAST score (Cannabis Abuse Screening Test), the ECAB scale (Cognitive Scale for Benzodiazepines Attachment), The DAST scale (Drug Abuse Screening Test), the ADOSPA questionnaire (Teens and psychoactive substances), etc. All BZD had been monitored by pharmacovigilance and addictovigilance networks. In Cote d’Ivoire, data on the prevalence of BZD dependence are rare. In the absence of addictovigilance system in this country, the commitment of the pharmacist to take on towards his patient the responsibility for achieving the preventive or curative objectives of drug therapy must be real with BZD. It is useful to carry out cross-sectional studies showing the main BZD used and the level of dependence of their users. The aim of our study was to determine in the context of neighbourhood pharmacies the modes of dispensing of BZD and the level of dependence of patients to these psychotropic drugs in Cote d’Ivoire. MATERIALS AND METHODS Study Type We carried out an observational study on the dispensing of BZD. The survey was conducted from December 2014 to August 2015 with a minimum of two week-time in 10 neighbourhood pharmacies in Abidjan (Cote d’Ivoire) on the basis of one pharmacy selected randomly in each district. Each pharmacy chosen was drawn among all pharmacies of each district. The complete list of pharmacies in the city of Abidjan came from the National order of Pharmacists. Method of Investigation The interview of the patient has been performed with a standard questionnaire in a private area guaranteeing the confidentiality of the information provided by the patient. Selection criteria of patients Our study included major patients (age ≥ 18 years), with a medical prescription of BZD or requiring spontaneously the delivery of BZD or soliciting a pharmaceutical advice for the delivery of BZD. Patients selected were those to whom the BZD was intended. All subjects in our study gave their consent to participate in the study. Assessment Scale of Benzodiazepine Dependence The Cognitive Scale for Benzodiazepines Attachment (ECAB scale) was used to measure the level of dependence to these psychotropic drugs. The ECAB questionnaire consists of 10 items scored 1 or 0. The rating process consist in assigning 1 point in case of answer "true" except for question 10, where the point is obtained in case of answer "false" and 0 point in the contrary case. The total score for the questionnaire is obtained by adding up the points from each item. The use of ECAB scale allows to J Hosp Clin Pharm| Volume 2 | Issue 4 | December 2016 15 Research & Reviews: Journal of Hospital and Clinical Pharmacy assess quickly (about 3 min) thoughts (cognitions) of a patient receiving BZD for several months with a good correlation vis-a- vis a possible dependence [19]. This scale has been validated in a sample of 52 psychiatric patients, hospitalized or outpatients consuming BZD daily for at least 3 months [19]. A score ≥ 6 differentiates dependent patients from non-dependent patients with test sensitivity of 94% and specificity of 81%. The diagnostic properties of ECAB scale and the limited number of questions showed that it can be used to assess attachment of outpatients to BZD.
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