Elsevier

Therapies

Volume 78, Issue 2, March–April 2023, Pages 157-164
Therapies

Women and pharmacology: Drugs and gender
Addictovigilance in women, the hidden part of the iceberg?

https://doi.org/10.1016/j.therap.2022.10.006Get rights and content

Summary

Epidemiology of substance use disorders and their complications is driven by a male predominance, and women, even if they are more and more prevalent, are never specifically represented in studies in the field. Apart from the time of pregnancy, which in itself requires specific prevention, treatment and follow-up, the importance of the sex of women in the complications of substance abuse is neglected. To illustrate, we described some characteristics of women identified in the addictovigilance information system in France and Europe, related to drug use disorders (both for illicit substances and medications). Even if the exposure to some psychoactive substances remains more prevalent in men, women, and particularly young women, seem to be more vulnerable to the adverse effects of these substances, as observed for opioid analgesics, benzodiazepines, cannabis and even nitrous oxide. It is now imperative that the female sex/gender be taken into consideration in addictovigilance expertise and in drug safety in general, even for substances for which use is predominantly male. In addition, the adequate management of the women requires the development of specific prevention and care strategies.

Section snippets

Abbreviations

    ASOS

    Antalgiques stupéfiants et ordonnances sécurisées

    DRAMES

    Décès en relation avec l’abus de médicaments et de substances

    EMCDDA

    European Monitoring Centre for Drugs and Drug Addiction

    GHB

    gamma hydroxybutyrate

    ICSR

    individual case safety report

    MDMA

    midoamfetamine (3,4-MethyleneDioxy-N-MethylAmphetamine)

    NPS

    new psychoactive substances

    N2O

    nitrous oxide

    OPPIDUM

    Observatoire des produits psychotropes illicites ou détournés de leur usage médicamenteux

    OSIAP

    Ordonnances suspectes indicateur d’abus possible

    SMQ

Addictovigilance monitoring

The French Addictovigilance Network was set up in the 1990s, in order to benefit from a proactive vigilance system targeted at substances with potential for abuse and dependence (except tobacco and alcohol), and to participate in a proactive and coordinated manner in the activities of the WHO expert committee on drug dependence. This specific drug and substance safety monitoring is based on spontaneous reporting by healthcare professionals of any serious case of misuse, abuse and drug

Panorama of addictovigilance reporting according to sex for the period 2020–2022

In order to provide some evidence about differences and similarities between women and men regarding reporting of abuse and dependence to drugs, we have examined information recorded in the WHO international pharmacovigilance database. This database named Vigibase® is the largest database of its kind in the world, with over 30 million reports of suspected adverse effects of medicines, submitted, since 1968, by member countries of the WHO's Program for International Drug Monitoring. It is

Prescription drug diversion

After an initial period of pilot studies in some areas, from 2001 onwards, the collection of suspect prescriptions has been performed by the French addictovigilance network, through the systematic periodic survey OSIAP. This survey provides relevant information about drug diversion along time as well as the profile of individuals who request these drugs with a potential of abuse [12], [13]. The first analysis at the national level exhibited different profiles of prescription drug diverters:

Nitrous oxide

It has been widely accepted for years that the incidental recreational use nitrous oxide (N2O) (“laughing gas”) elicits virtually no harm [56]. Recently, the French Addictovigilance Network raised the issue of the increase in serious health complications in parallel with the significant increase in non-medical use of N2O in France. These unexpected outcomes included severe neurological damage that occurred during the massive and/or prolonged consumption [57], [58]. From a first report of the

Conclusion

This panorama plaids for the necessary consideration of women in addictovigilance reviews. Substance use disorders are considered to be more frequent in men, consequently men predominate in most of studies investigating substance use disorders, with sex most often considered as a confounding factor. Investigating factors associated with unfavorable outcomes of substance use must be stratified on sex, allowing to identify women specificities. However, because of gender differences (women can be

Funding sources

This research work did not receive any specific financial support.

Disclosure of interest

The author declares that she has no competing interest.

Acknowledgments

The author would like to acknowledge all the contributors (many of them women) of the French addictovigilance network, who made it possible to collect this valuable information.

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