La Lettre d`addictovigilance – n°12, avril 2015

La Lettre d’addictovigilance – n°12, avril 2015!
!
!
!
.! Des! douleurs! abdominales! et! vomissements!soulagés! par! des! douches! chaudes!?! Penser! au!
cannabis!!
"#!$%&'()*#!+,&&,-.&)/'#!)0!$%&'()*#!'12%3#(4*5$#!+,&&,-.&)/'#!,!464!'4+(.6!3)0(!7,!3(#*.5(#!
8).$! #&! 9::;! 3,(! <77#&! =>! !"# $%&?! @&#! $4(.#! '#! +,$! ,! 464! (4+#**#&6! 30-7.4#! 3,(! 0&#! 4A0.3#!
*,($#.77,.$#B9! C7! #$6! +,(,+64(.$4! 3,(! '#$! 43.$)'#$! (43464$! '#! &,0$4#$! #6! D)*.$$#*#&6$! $0(D#&,&6!
+2#E!'#$!+)&$)**,6#0($!+2()&.A0#$!'#!+,&&,-.$B!F#$!')07#0($!,-')*.&,7#$!43.G,$6(.A0#$!)0!34(.H
)*-.7.+,7#$! $)&6! G4&4(,7#*#&6! 3(4$#&6#$I! ,.&$.! A0J0&#! 3#(6#! '#! 3).'$B! C7! &J%! ,! #&! 3(.&+.3#! 3,$! '#!
6()0-7#$! '0! 6(,&$.6! #6! 7#! -.7,&! 3,(,+7.&.A0#! K-.)7)G.#I! .*,G#(.#I! #&')$+)3.#L! #$6! &)(*,7B! M#!
$%&'()*#!$0(D.#&6I!',&$!7,!3703,(6!'#$!+,$I!370$.#0($!,&&4#$!,3(5$!7#!'4-06! '#! 7,!+)&$)**,6.)&I!
$,&$!&)6.)&!'#!'0(4#!)0!'#!$#0.7!'#!+)&$)**,6.)&B!"#$!$%*36N*#$I!$0(D#&,&6!3706N6!7#!*,6.&I!$)&6!
$)07,G4$! #88.+,+#*#&6! *,.$! 6#*3)(,.(#*#&6! 3,(! '#$! ')0+2#$! )0! '#$! -,.&$! +2,0'$B! ",!
32%$.)3,62)7)G.#!'#!+#!$%&'()*#!#6!7#$!8,+6#0($!3(4'.$3)$,&6$!$)&6!*,7!+)&&0$B!
O#07!7#!$#D(,G#!'48.&.6.8!#&!+,&&,-.$!3#(*#6!7,!'.$3,(.6.)&!'0!$%&'()*#!+,&&,-.&)/'#!P!.7!(4,33,(,.6!
G4&4(,7#*#&6! 7)($! '#! 7,! (#3(.$#! '#! +)&$)**,6.)&I! *,.$! ,0$$.! #&! +,$! '#! +)&$)**,6.)&! '#!
+,&&,-.&)/'#$!'#!$%&625$#BQ!M#$!'#(&.#($I!+)&6(,.(#*#&6!,0!+,&&,-.$I!&#!$)&6!3,$!'46#+6,-7#$!3,(!
7#$!6#$6$!0(.&,.(#$!+7,$$.A0#$B!
M2#E! 0&#! 3#($)&&#! 3(4$#&6,&6! '#$! 43.$)'#$! (4+0((#&6$! '#! D)*.$$#*#&6$! #6! '#! ')07#0($!
,-')*.&,7#$I! &)6,**#&6! +,7*4$! 3,(! 7,! 3(.$#! '#! -,.&$! )0! ')0+2#$! +2,0'#$I! 7,! 3(.$#! 3()7)&G4#! #6!
A0)6.'.#&&#!'#!+,&&,-.$!)0!'#!+,&&,-.&)/'#$!'#!$%&625$#!').6!R6(#!(#+2#(+24#B!
'&#(%%!)#*+##6!,7&#,-"#.//0#1#23#4#'2556'27/##
.&#8!9":)%;):#*##6!,7&#<!=#>!?#@)"#./'0#AB:-B#C9!BB!D###
3&#8;EF#8G##6!,7&#>$H:#I%;)#J9:E#./'0#1#KL#4#''506''5L#####!!!!!!!!!!!=)2,&!F#&.E)6#
#
.! Attention! aux! interactions! entre! médicament! de! l’alcoolo<dépendance! et! médicament! de!
substitution!aux!opiacés!
S70$.#0($! +,$! '#! $%&'()*#! '#! $#D(,G#! +2#E! '#$! 3,6.#&6$! $)0$! *4'.+,*#&6! '#! $0-$6.606.)&! ,0T!
)3.,+4$! KUOVLI! *462,')&#! )0! -03(4&)(32.&#! $0(D#&0! ,3(5$! 7,! 3(.$#! 'J0&! *4'.+,*#&6! '#!
7J,7+))7)'43#&',&+#! K&,76(#T)&#! ',&$! 9! +,$I! &,7*485&#! ',&$! 9! ,06(#$! +,$L! )&6! (4+#**#&6! 464!
$.G&,74$B!!
@&!(,33#7!$0(!7#$!*)',7.64$!'#!3(#$+(.36.)&!'#$!6(,.6#*#&6$!'0!$#D(,G#!,7+))7.A0#!+2#E!'#$!3,6.#&6$!
$)0$!UOV!&)0$!$#*-7#!06.7#!W!
"#!&,7*485&#!KO#7.&+()XL!#$6!0&!,&6,G)&.$6#!'#$!(4+#36#0($!)3.,+4$!Y!#6!δ!#6!0&!,G)&.$6#!3,(6.#7!'#$!
(4+#36#0($! κ!#6!7,! &,76(#T)&#! KZ#D.,XL!#$6!0&! ,&6,G)&.$6#! '#$! (4+#36#0($! ,0T! )3.,+4$B! M#$!
*4'.+,*#&6$!3#(*#66#&6!'#!(4'0.(#!7,!+)&$)**,6.)&!'J,7+))7!+2#E!7#$!$0[#6$!'43#&',&6$!G(\+#!]!
0&#!,+6.)&!$0(!7#$!8)&+6.)&$!7.*-.A0#$B!")($!'#!7#0(!,$$)+.,6.)&!,D#+!0&!,G)&.$6#!K*462,')&#L!)0!0&!
,G)&.$6#H,&6,G)&.$6#! K-03(4&)(32.&#LI! 7#! -7)+,G#! +)*346.6.8! '#$! (4+#36#0($! #$6! ]! 7J)(.G.&#! 'J0&#!
.&#88.+,+.64!'#$!UOVI!,D#+!(.$A0#!'J,33,(.6.)&!'J0&!$%&'()*#!'#!$#D(,G#B!M#66#!,$$)+.,6.)&!#$6!')&+!
+)&6(#H.&'.A04#B!
^,7*485&#! #6! &,76(#T)&#! $)&6! 4G,7#*#&6! +)&6(#H.&'.A04$! ,D#+! 7#$! ,&6,7G.A0#$! *)(32.&.A0#$! )0!
,06(#$! ,G)&.$6#$! )3.,+4$! K,78#&6,&.7I! +)'4.&#I! !"EBLI! 7J,$$)+.,6.)&! 3)0D,&6! R6(#! $# M;);M$!]! 7J)(.G.&#!
'J0&#!'.*.&06.)&I!D).(#!'10&#!,-$#&+#!'J#88.+,+.64!)0!'J0&!$%&'()*#!'#!$#D(,G#B!
_&8.&I! 7#$! ,06(#$! *4'.+,*#&6$! 06.7.$4$! +)&6(#! 7,! '43#&',&+#! ]! 7J,7+))7! K-,+7)85&#I! ,+,*3()$,6#I!
'.$078.(,*#L!&#!$)&6!3,$!+)&+#(&4$!30.$A0J.7$!&J,G.$$#&6!3,$!$0(!7#$!(4+#36#0($!)3.,+4$B! ! !!
U,(.)&!`,.77,('!
!
!
!
!
!

Centre!d’addictovigilance!–!Service!de!pharmacologie!<!Hôpital!Pellegrin,!CHU!de!Bordeaux!<!33076!Bordeaux!cedex!!
",!7#66(#!!'J,''.+6)D.G.7,&+#!#$6!'.$3)&.-7#!$0(!a!
www.pharmacoepi.eu!
!
.!Dextrométhorphane!et!détournement!
"#!'#T6()*462)(32,&#!KFbUL! #$6! 0&!'4(.D4!*)(32.&.A0#! ,&6.60$$.8! 'J,+6.)&!+#&6(,7#I!,G)&.$6#! '0!
(4+#36#0(! )3.,+4! σ?I! ,&6,G)&.$6#! '0! (4+#36#0(! ^UF<!#6!,&6,G)&.$6#! &.+)6.&.A0#! C7! 3(4$#&6#! '#$!
$.*.7.60'#$! 32,(*,+)7)G.A0#$! ,D#+! 7,! 32#&+%+7.'.&#! #6! 7,! c46,*.&#! #&! +#! A0.! +)&+#(&#! $#$! #88#6$!
2,770+.&)G5&#$B!
"J,-0$! '#! FbU! 3,(! 7#$! ,')7#$+#&6$! #$6! 0&! 3()-75*#! '#! $,&64! 30-7.A0#! ,0T! _6,6$H@&.$! '#30.$! ,0!
*).&$! 9::;B! "#$! 3(#*.#($! +,$! 'J,-0$! )&6! 464! $.G&,74$!]! 3,(6.(! '#!9::Q! #&! !d(,&+#! a!.7! $J,G.$$,.6!
#$$#&6.#77#*#&6! '#! 3)7%6)T.+)*,&#$I! \G4$! 'J0&#! 6(#&6,.&#! 'J,&&4#$B! F#30.$! 9::eI! #&! (#D,&+2#I! 7,!
*,[)(.64! '#$! +,$! &)6.8.4$!,0T! +#&6(#$! 'J,''.+6)D.G.7,&+#! K+,$! 3,(8).$! G(,D#$I! ,D#+!2)$3.6,7.$,6.)&L!
+)&+#(&#&6! '#$! ,')7#$+#&6$! )0! '#$! [#0&#$! ,'076#$!K\G#! *)%#&!a! 9?I;! ,&$I! #T6(R*#$!a! ??H;e! ,&$L!
+)&8.(*,&6!,.&$.!7,!3)307,(.64!+().$$,&6#!+2#E!7#$!,')7#$+#&6$!8(,&f,.$B!!
_&!9:?9I!7J<^OU!,!,7#(64!7#$!32,(*,+.#&$!$0(!7,!&4+#$$.64!'JR6(#!D.G.7,&6$!7)($!'#!'#*,&'#$!'#!+#!
*4'.+,*#&6! 3,(! '#$! ,')7#$+#&6$B! "#! FbU!,! 464!(#6.(4! #&! &)D#*-(#! 9:?9! '#! 7,! 7.$6#! '#$!
*4'.+,*#&6$! '#! *4'.+,6.)&! )88.+.&,7#! 3)0D,&6! R6(#! 37,+4$! g!'#D,&6! 7#! +)*36).(!h!B?!F)0E#!
$34+.,7.64$! '#! FbU! '#$6.&4#$! ]! 7,! D).#! )(,7#! K$.()3I! +,3$07#! *)77#I! G4707#L! ',&$! 7#! 6(,.6#*#&6! '#!
+)0(6#!'0(4#!'#$!6)0T!$5+2#$!,D,.#&6!464!.&$+(.6#$!$0(!+#66#!7.$6#!'#!*4'.+,*#&6$!#&!7.-(#!,++5$!#&!
9::iB9!!
_&! &)D#*-(#! 9:?;QI! 7J<^OU! ,! (,33#74! 7#! (.$A0#! 'J0$,G#! '46)0(&4! .*3)(6,&6! '#! +#! *4'.+,*#&6!
,3(5$! ,D).(! .&8)(*4! #&! $#36#*-(#! 9:?;! 7#$! *4'#+.&$! G4&4(,7.$6#$I! ,''.+6)7)G0#$I! 34'.,6(#$I!
*4'#+.&$!#T#(f,&6!#&! *.7.#0!$+)7,.(#I!#&! 37,&&.&G!8,*.7.,7!#6! #&!SUCI!,.&$.! A0#!7#$!3()8#$$.)&&#7$!
'#$!,$$)+.,6.)&$!'#!3(4D#&6.)&!'#!'()G0#$!3)0(!7#$![#0&#$B!!
"J<^OU!(4.65(#!]!+#66#!)++,$.)&!'#$!(#+)**,&',6.)&$!D#($!7#$!3()8#$$.)&&#7$!'#!$,&64!a!!
H!R6(#!3,(6.+07.5(#*#&6!D.G.7,&6!8,+#!]!6)06#!'#*,&'#!'#!'#T6()*462)(32,&#!$0$3#+6#I!4*,&,&6!#&!
3,(6.+07.#(!'#![#0&#$!,'076#$!)0!'J,')7#$+#&6$I!!
H!$J,$$0(#(!A0#!7#$!3,6.#&6$!&J)&6!3,$!'J,&64+4'#&6$!'J,-0$I!'#!'43#&',&+#!)0!'#!+)*3)(6#*#&6!A0.!
3)0((,.6!$033)$#(!0&!0$,G#!'46)0(&4!7)($!'#!7,!3(#$+(.36.)&!)0!'#!7,!'47.D(,&+#I!!
H!#&! +,$! '#!')06#I! 3(#$+(.(#!)0! '47.D(#(!0&!,06(#! ,&6.60$$.8I! )0! &#! '47.D(#(I!3)0(! 7#$!32,(*,+.#&$I!
A0J0&#!$#07#!-)j6#!]!7,!8).$B!
'&#NOE&#?;9&#PO)&#(QR>#?-#.5#):=!MS9!#./'.#C:9"$)"#;)BE9;C";:)#B-9#%$#B-9#%$#%;B"!#?!B#MO?;E$M!)"B#?!#MO?;E$";:)#:TT;E;)$%!#M!)";:))O!#
U#%V$9";E%!#<&#2'.'6./.#IRJ#A*WX#K#Y$)=&#./'3D#
.&#NOE&#?;9&#PO)&#(QR>#?-#'!9#Y-;%%!"#.//K#C:9"$)"#;)BE9;C";:)#B-9#%$#%;B"!#?!B#MO?;E$M!)"B#?!#MO?;E$";:)#:TT;E;)$%!#M!)";:))O!#U#%V$9";E%!#
<&#2'.'6./.#IRJ#A*WX#5#Y-;%%!"#.//KD#
3&#(QR>&#8-%%!";)#Z;P;%$)E!BX#./'0#1#53&##
0&# (QR>&# [B$P!# ?O":-9)O# ?!# MO?;E$M!)"B# $)";"-BB;TB# U# S$B!# ?!# ?!\"9:MO"]:9C]$)!# E]!^# %!B# $?:%!BE!)"B# !"# %!B# Y!-)!B# $?-%"!B# 6# J:;)"#
?_@)T:9M$";:)X#.5#):=!MS9!#./'0&#
!!!!!!!!!!!!U,(.#!k,0*#D.#.77#!
!
.!Consommation!de!cannabis!:!un!signal!pour!une!augmentation!du!risque!cardiovasculaire!?!
@&!,(6.+7#!,!(4+#**#&6!464!30-7.4!]!3,(6.(!'#!Ql!+,$!'#!+)*37.+,6.)&$!+,('.)HD,$+07,.(#$!+2#E!'#$!
+)&$)**,6#0($!'#!+,&&,-.$!$.G&,74$!#&!d(,&+#!,0T!+#&6(#$!'J,''.+6)D.G.7,&+#!#&6(#!9::m!#6!9:?:B?!
M#$!+)*37.+,6.)&$!+,('.)D,$+07,.(#$!(#3(4$#&6,.#&6!?Ii!n!'#$!+,$!$.G&,74$!$0(!+#66#!34(.)'#!,D#+!7#!
+,&&,-.$I!,D#+!0&#!,0G*#&6,6.)&!'#!+#66#!3()3)(6.)&!'J,&&4#!#&!,&&4#!K'#!?I?!n!#&!9::m!]!QIm!n!
#&!9:?:LB!C7!$J,G.$$,.6!3(.&+.3,7#*#&6!'J2)**#$!KilIo!nL!P!7J\G#!*)%#&!46,.6!'#!Q;IQ!,&$B!C7!%!,D,.6!
99! +)*37.+,6.)&$! +,('.,A0#$! K')&6! 9:! +,$! '#! $%&'()*#! +)()&,.(#! ,.G0LI! ?:! +)*37.+,6.)&$!
34(.324(.A0#$! K,(64(.)3,62.#$L! #6! Q! +)*37.+,6.)&$! +4(4-(,7#$! K,&G.)3,62.#I! +4+.64! 6(,&$.6).(#I!
$3,$*#!'#!7J,(65(#!+4(4-(,7#LB!^#08!3,6.#&6$!$)&6!'4+4'4$B!
",!$)0$H&)6.8.+,6.)&!#&!,''.+6)D.G.7,&+#!#$6!6(5$!.*3)(6,&6#!#6!0&#!$)0$H#$6.*,6.)&!'0!&)*-(#!'#!
+,$! $0(D#&0$! #&! d(,&+#! 3#&',&6! 7,! 34(.)'#! 'J460'#! #$6! ')&+! 3()-,-7#B! ",! 3(4D,7#&+#!'#!
+)&$)**,6.)&!'#!+,&&,-.$!#&!d(,&+#!#$6!.*3)(6,&6#!a!#&!9:??!#&6(#!;!]!e!n!'#$!,')7#$+#&6$!'#!?o!
,&$!+)&$)**,.#&6!(4G07.5(#*#&6!'0!+,&&,-.$I!A0.!+)&6.&0#!]!R6(#!3#(f0!3,(!7#!G(,&'!30-7.+!+)**#!
3#0! ',&G#(#0TB! M#3#&',&6I! .7! +)&D.#&6! 'JR6(#! +)&$+.#&6! A0#! 7#! +,&&,-.$! #$6!0&! 3)6#&6.#7! 8,+6#0(!
'4+7#&+2,&6!'J0&#!+)*37.+,6.)&!+,('.)HD,$+07,.(#!+2#E!7J,'076#![#0&#B!!
'&#*:-$)Y-B##6!,7&#*#(M#+!$9"#(BB:E#./'0#1#3#4#!///53K#!!!!!!!!!!!!!!!!!<*47.#!F,D#70%!
!