Tianeptine and doctor shopping in France

http://www.ncbi.nlm.nih.gov/pubmed/21210844

Fundam Clin Pharmacol. 2011 Jan 7. doi: 10.1111/j.1472-8206.2010.00906.x. [Epub ahead of print]
Assessment of abuse of tianeptine from a reimbursement database using 'doctor-shopping' as an indicator.
Rouby F, Pradel V, Frauger E, Pauly V, Natali F, Reggio P, Thirion X, Micallef J.

CEIP-Addictovigilance PACA-Corse, Fédération de Pharmacologie et de Toxicologie, CHU Timone, Marseille, France Institut des Neurosciences Cognitives de la Méditerranée, Faculté de Médecine, Université de la Méditerranée-CNRS, UMR 6193, France CEIP-Addictovigilance PACA-Corse, Laboratoire de Santé Publique, Faculté de médecine, Marseille, France Direction Régionale du Service Médicale de la Région Provence-Alpes-Côte d'Azur et Corse (CNAMTS) 195 bd Chave 13392 Marseille Cedex 05, France.

Abstract
Doctor-shopping is a patient behaviour characterized by simultaneous consultations of several physicians during the same period. Some case reports have described an abuse of tianeptine, an atypical antidepressant. Our objective was to assess the extent of abuse of this drug with a method quantifying doctor-shopping in comparison with other antidepressants and benzodiazepines (BZD). All dispensations of antidepressants and BZD during the year 2005 in a French area of 4.5 million inhabitants were extracted from a reimbursement database. For each patient, two quantities were computed: quantity dispensed and obtained by doctor-shopping. Tianeptine and other drugs were compared using their doctor-shopping indicator (DSI), defined as the percentage of drug obtained by doctor-shopping among dispensed quantity; 410 525 patients received at least one antidepressant dispensation during the year 2005. Tianeptine was the sixth most dispensed antidepressant. The DSI of tianeptine was 2.0%, ranking it first among antidepressant (the second being mianserine with a DSI of 1%). Flunitrazepam has the highest DSI (30.2%), the DSI of the five following BZD (clonazepam, zolpidem, oxazepam, diazepam, bromazepam) range from 3.0% to 2.0%. Tianeptine is associated with higher DSI, compared with other antidepressants, suggesting that it may be subject to abuse in the population. Moreover, its DSI as a measure of diversion is similar to the DSI of diazepam or bromazepam.