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MisuMedPT : use and misuse of psychoactive medicines in Portugal
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Chapter 1 introduces the topic of medicines’ misuse and defines the concept, provides an overview of the drug problem and details the pharmacoepidemiological resources that can be used in drug misuse monitoring.
Chapter 2 refers to the scoping review conducted with the aim of synthesising the body of evidence currently available on medicines’ misuse: Chapter 2.1 includes the published protocol detailing the methodology to follow, and Chapter 2.2 the published scoping review. Prescription opioids and benzodiazepines/z-drugs (BZDR) have shown to have higher misuse potential, and the main risk factors for PMed misuse identified were female sex, older age, mental health or alcohol use disorders, concomitant use of several psychoactive substances, and history of substance use/addiction.
Chapter 3 addresses the use and misuse of PMed in Portugal, with Chapter 3.1 estimating the prevalence of PMed use in the Lisbon and Tagus Valley region – 21 .7%, with older age and female predominance. Misuse analysis showed chronic PMed use in 24.5% of PMed total users, and doctor shopping was generally low except for fentanyl which requires close monitoring. About 24.4% of total BZDR users were chronic; 72.6% of total OA chronic users were long-term concomitant (LTC) users with BZDR, while 32.4% were LTC users with antidepressants. Apparently, most OA are not used to treat chronic chancer pain.
In Chapter 4, the morbimortality consequences of misuse of PMed in Portugal are investigated in a repeated multi-source cross-sectional study – Chapter 4.1. Using nationwide PMed-related mortality, poisoning, hospitalisation and adverse drug reaction data, we concluded that the harmful consequences of PMed misuse occur more frequently in women and in the elderly, involving BZDR and antidepressants, especially tricyclic. These antidepressants, as well as substance combinations, including with alcohol and/or illicit drugs, increase PMed contribution and seriousness of morbimortality events.
Chapter 5 discusses the MisuMedPT project global results. Overall, the conducted research shows that there is the need for systematic and regular evidence generation on PMed use, misuse and its possible adverse consequences, to be gathered at national level by all Member States and periodically reported to an EU centralised system created to monitor PMed use and misuse.
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Medicamentos psicoativos mau uso de medicamentos consequências de morbimortalidade uso crónico doctor shopping Psychoactive medicines prescription drug misuse morbimortality consequences chronic use