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Overview

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Non-opioid psychotropic drugs include several categories of products whose function is to act on brain activity:

• anxiolytics or tranquillisers: they reduce anxiety and the symptoms of anxiety (insomnia, muscle tension, etc.). The most commonly prescribed, especially for long periods of time, belong to the benzodiazepine family, which quickly lead to physical dependence and tolerance;
• hypnotics or soporifics: these are intended to induce and/or maintain sleep. As a result, they can reduce alertness. Many are benzodiazepines;
• antidepressants: intended to treat depression, they rarely lead to addictive use;
• antipsychotics (neuroleptics), mainly prescribed for psychoses (e.g. schizophrenia);
• mood regulators (lithium in particular) mainly prescribed for bipolar disorder;
• psychostimulants: methylphenidate (Ritalin^®) and modafinil (Modiodal^®) mainly prescribed for attention deficit hyperactivity disorder in children.

In the vast majority of cases, the use of these drugs is not addictive, but therapeutic, sometimes in the context of self-medication (drugs not prescribed to the person taking them). However, due to the disturbances in alertness and dependence that some of these drugs cause, they can lead to problematic or risky uses. While some classes of psychotropic drugs appear to be very rarely diverted or misused (antidepressants, neuroleptics, lithium), others are frequently diverted by drug users (anxiolytics and hypnotics). Finally, some molecules (such as the antiparkinsonian trihexyphenidyl [Artane^®], methylphenidate [Ritalin^®], pregabalin [Lyrica^®] or tropicamide [Mydriaticum^®]) are sometimes used in smaller user groups.

Production/supply

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Licit products not easily accessible to law enforcement

In the general population, psychotropic drugs are received on prescription, even if they have not always been prescribed to the user themselves.

The use of the parallel market, which is very visible in certain urban areas, exists but trafficking is rarely organised and very few drug users seem to purchase these drugs on the Internet. According to the OSIAP 2019 study (Suspicious Prescriptions Indicating Possible Abuse by ANSM/CEIP-A), pregabalin was the substance most frequently falsely prescribed in 2019. In order to limit the misuse of pregabalin, part of the narcotics regulation has been applied to pregabalin-based drugs since 24 May 2021: prescription on a secure prescription basis and maximum prescription duration limited to 6 months. Four benzodiazepines or related drugs are among the top ten molecules involved in the use of falsified prescriptions: bromazepam (6^th), alprazolam (7^th), zolpidem (8^th) and zopiclone (10^th). There was a drop in the number of citations for tropicamide, which is no longer among the 10 most cited molecules. This decrease is linked to the changes in the conditions for prescribing and dispensing the 10 ml bottle since January 2019.

Reference :

• CEIP-A de Toulouse. Principaux résultats de l'enquête OSIAP 2019. [Main results of the OSIAP 2019 survey.] Saint-Denis, Agence nationale de sécurité du médicament et des produits de santé (ANSM), 2021, 2 p.

Use

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In the adolescent population

In 2018, lifetime use of a tranquilliser or soporific without a prescription was reported by 7.0% of high school students (vs 10.8% in 2015), with girls still more often affected than boys (7.6% vs 6.4%).
In 2017, more than one in five 17-year-olds reported that they had used a psychotropic drug in their lifetime (22% vs 25% in 2014), with girls far more likely to than boys (30% vs 14%). Tranquillisers (13% vs 16% in 2014) and soporifics (10% vs 13%) are among the most commonly cited. The reported prevalence of antidepressants (5.2%) and stimulants (1.6%) remained stable (unpublished ESCAPAD 2017 data).

Reference :

• Spilka S., Le Nézet O., Janssen E., Brissot A., Philippon A., Shah J., Chyderiotis S. Drug use in 17-year-olds: analysis of the 2017 ESCAPAD survey. Tendances, OFDT, 2018, no. 123, 8 p.

In the adult population

 A decrease in the overall level of use

The most widely consumed non-opioid psychotropic drugs in France are anxiolytics, with 1.4 boxes reimbursed per inhabitant aged 20 and over in 2017, compared with 0.7 boxes of hypnotics and 1.2 boxes of antidepressants. Use, or more precisely reimbursements, of anxiolytics decreased by 6% over the period 2012-2017. The decrease was more significant for hypnotics (down 28%), while antidepressants remained stable. Reimbursements of methylphenidate (Ritalin^® or others) fluctuated from 2012 (508 606 boxes) to 2017 (813 500 boxes) with a peak in 2014 (936 939 boxes).

Use by women increases with age...

In 2017, 21% of people aged 15 and over were reimbursed for at least one psychotropic drug during the year (15% for an anxiolytic, 6% for a hypnotic, 9% for an antidepressant, 0.5% for a mood regulator and 2% for a neuroleptic). Reimbursements were significantly more frequent among women (26% compared to 16% among men) and increased sharply with age, with the gender gap widening as people aged. Among women, they increased from 9% among 15-24-year-olds to 49% among those aged 85 and over. For men, it was 5% among 15-25-year-olds, rising to 33% among those aged 85 and over.

References :

• CNAM. Médicaments délivrés par les pharmacies de ville par type de prescripteur [Drugs dispensed by city pharmacies by type of prescriber] - Medic'AM - in 2017, Caisse nationale de l'Assurance Maladie, 2018.
• Cadet-Taïrou A., Brisacier A.-C. Médicaments psychotropes non opioïdes. [Non-opioid psychotropic drugs], in Drogues et addictions, données essentielles. Paris, OFDT, 2019, p. 147-150.

Among drug users

Drug users in contact with the health or social system also acquire benzodiazepines. In 2019, 42% of the users of harm reduction facilities (CAARUD), users who are often in a vulnerable situation, declared that they had taken drugs in the past month. Two-thirds of them seem to comply with the therapeutic framework (the drug is obtained by prescription, taken orally with a view to treatment), even if the boundary between treatment and “getting high” often appears blurred. The vast majority of benzodiazepines are still taken orally (96%). The use of these drugs outside the therapeutic protocol is proportionally more significant among the youngest, men, the most vulnerable and heavily poly-drug users.

Reference :

• Cadet-Taïrou A., Janssen E., Guilbaud F. Profils et pratiques des usagers reçus en CAARUD en 2019. [Profiles and practices of users received at the CAARUD in 2019.] Tendances, OFDT, 2020, no. 142, 4 p.

Consequences

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An insufficiently estimated health and social impact

The use of psychotropic drugs is in the vast majority of cases a therapeutic practice. Not all use is therefore problematic.

Therapeutic use of benzodiazepines results in impaired alertness and consciousness, with particular risks when driving a vehicle (60-80% higher risk of accident and eightfold higher when combined with alcohol) and the risk of falls in the elderly. In 2019, 42% of the people receiving treatment in specialised drug treatment centres (CSAPA) reported that they had used benzodiazepines in the past month.

Cases of death related to drug and substance abuse are collected by the DRAMES scheme, which is based on the results of toxicological analyses carried out within the forensic framework of a search for causes of death. Non-opioid psychotropic drugs were involved alone or in combination in 14% of deaths in 2019 (2019 DRAMES Survey data, CEIP-A Grenoble-ANSM).

A risk of criminal use

Finally, benzodiazepines (the active ingredient in most sleeping pills and tranquillisers) administered to a victim without their knowledge are sometimes used for criminal purposes (rape, theft, etc.). In 2019, alprazolam, bromazepam and diazepam were the most commonly used benzodiazepines in reported drug-facilitated sexual assault cases.

Reference :

• CEIP-A Île-de-France. Soumission chimique. Résultats de l'enquête 2019 [Drug-facilitated sexual assault. Results of the 2019 survey], ANSM, CEIP-A, 2021, 2 p.

Legal framework and recent public policies

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The regulation of the use of pharmaceutical products covers a wide variety of substances. It differs according to their classification based on the associated risks. Drugs are subject to regulation in terms of production, marketing, prescribing and dispensing. They are classified as “poisonous substances” and are only available on prescription. Drugs are included in the list of narcotics when they are at high risk of dependence or misuse, in list I when they are considered dangerous or in list II for substances considered potentially dangerous. These different categories of substances are based on the classifications ratified by the United Nations under the Single Convention on Narcotic Drugs of 1961, the Vienna Convention on Psychotropic Substances of 1971 and the Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988.

Among the non-opioid psychotropic drugs, only methylphenidate (Ritalin®) is listed as a narcotic. Other non-opiate psychotropic drugs are mostly classified in list 1 (although some are subject to part of the narcotics regulations).

It should be remembered that the illicit use, possession, supply, transfer, acquisition or transport - i.e. not in accordance with medical prescriptions - of drugs on the list of narcotics or similar substances is punishable as for any other narcotic. Thus, the offence of use is punishable by a maximum of one year's imprisonment, a fine of €3 750, and even a training course to raise awareness of the dangers of using narcotics, as an additional penalty (Art. L. 3421-1 of the French Public Health Code). On the other hand, the misuse or abuse of psychotropic drugs classified in list I of poisonous substances is not criminally punishable.

Last update: September 2022