La prescription d’opioïdes forts (OF) dans le traitement de la douleur cancéreuse (DC), et plus encore dans la douleur non cancéreuse (DNC), reste l’objet de nombreux débats. L’objectif de cette enquête téléphonique conduite auprès de 100 médecins généralistes (MG) prescripteurs d’OF, était d’identifier leur perception des risques de survenue d’une dépendance, ainsi que les moyens mis en place pour la détecter et la prendre en charge. Ainsi, pour les médecins interrogés, 15 % des patients souffrants de DNC contre 10 % pour la DC seraient à risques de développer une dépendance. Les principaux facteurs de risques des patients sont les antécédents de toxicomanie, une dépendance à d’autres substances et une pathologie psychiatrique concomitante. La perception du risque de dépendance freine la prescription d’OF dans la DNC pour un tiers des MG, alors que cela n’est pas le cas dans la DC. La durée du traitement, suivie de la co-prescription de psychotropes et une dose élevée de l’OF, sont perçues comme les principaux facteurs de risques des traitements. Enfin, seul un tiers des MG déclarent systématiquement rechercher la survenue d’une dépendance.

The prescription of strong opioids (SO) in the treatment of malignant pain (MP), and even more in non-malignant pain (NMP), remains a matter of debate.

The aim of this survey, conducted by phone in 100 general practitioners (GPs) prescribing SO, was to identify their perception of addiction risks and the means how to detect and manage them.

These interviewed prescribers were selected to be representative of GP prescribing SO in France. Ten questions were administered with the aim to identify risks of addiction occurrence, factors favoring this occurrence and strategies used to detect and to manage them.

Fifteen per cent of patients with NMP and 10% with MP were perceived as at risk of developing an addiction. Main patient's factors in cause were thought to be a previous personal or familial history of drug addiction, addiction to other substances such as psychoactive drugs and concomitant psychiatric pathology. GPs consider that patients suffering from bipolar disorders, schizophrenia, anxious and depressive disorders are more suitable to develop an addiction to SO. The perceived risk of addiction refrained one third of GPs from prescribing SO to NMP patients, whereas this was not the case in MP. Cancer pain is considered as a clinical condition where advantage takes it on the inconvenience. The most frequent risks for a SO prescription are: duration of prescription, co-prescription of psychoactive drugs and a high dose of SO. GPs consider that morphine and an immediate release (IR) form could be more frequently responsible for an addiction occurrence. Sixty per cent of the interviewed GPs declared checking clinical signs of an addiction but only a third checks them systematically. In case of addiction 2/3 asks for a colleague and 50% adapt the prescription. Only 8% discontinue the SO treatment.

For GPs the main risks of addiction to SO are: patients profile and duration of treatment. This risk of addiction limits SO prescription in NMP but not in case of MP. GPs check signs of SO addiction frequently but not systematically and they consider that the choice of molecule and an IR form could have an important impact on this occurrence.