Julie Dupouy

Opioid medications play a central role in pain management but are associated with significant risks, including dependence, opioid use disorder (OUD), and overdose. In response to rising concerns, the French National Authority for Health convened a multidisciplinary working group to develop updated guidelines on the appropriate use of opioids. These recommendations, grounded in the high-level international evidence and developed through a rigorous formal consensus method, represent the most comprehensive and recent guidelines addressing the entire opioid pharmacological class, regardless of indication. The first part focuses on the clinical use of opioid analgesics in acute and chronic pain, both cancer-related and non-cancer-related. The guidelines emphasize prudent prescribing, prioritization of non-opioid therapies, and the integration of multimodal analgesia. Specific clinical situations are addressed, including management in primary care, emergency settings, postoperative care, inpatient treatment, and the perioperative management of patients already receiving opioids or opioid agonist treatment. Practical tools such as equianalgesic conversion principles, criteria for opioid rotation, and strategies to minimize adverse effects are provided to support prescribers. By considering opioids as a single pharmacological class, these guidelines enable consistent principles to be applied across diverse clinical contexts, from the initiation of short-term opioid therapy to the safe management of patients with complex dependence profiles. Although developed in France, the recommendations are intended to have international relevance, given their reliance on global evidence and their focus on balancing effective pain relief with risk reduction. A second part, addressing the prevention and management of OUD and overdoses, complements the present manuscript.

Opioid use disorder (OUD) and overdoses represent critical challenges linked to the widespread availability of opioid medications. To address these risks, the French National Authority for Health convened a multidisciplinary working group to develop comprehensive guidelines on the prevention and management of OUD and overdoses. These recommendations expand on the second part of the guidelines, which specifically addressed the prevention and management of OUD and overdoses. Grounded in the highest level of international evidence and developed through a rigorous formal consensus process, the guidelines emphasize appropriate opioid prescribing as the cornerstone of prevention. They provide practical recommendations for identifying patients at risk, detecting problematic use early, and initiating opioid agonist treatment when indicated. The role of naloxone as an essential tool to prevent fatal overdoses is highlighted, along with strategies for coordinated and multidisciplinary care across diverse healthcare settings. By integrating prevention, treatment, and harm reduction measures, these guidelines seek to balance legitimate access to opioid analgesics with robust safeguards against opioid use disorder and overdose. Although developed within the French healthcare system, their strong evidence base and underlying clinical principles make them applicable to international practice. Together with the first part on pain management, they constitute one of the most comprehensive and up-to-date sets of recommendations on the safe and effective use of opioid medications.

Background. The diagnosis of cancer is communicated to a patient during a consultation designed to deliver the news, which incorporates a structured timeline and a multidisciplinary approach. However, prior to the start of oncological care, the patient will need to consult their general practitioner (GP). The GP is involved in the early stages of the diagnostic pathway, carrying out screening, identifying symptoms and coordinating the pathway. This consultation prior to the diagnosis, known as the ‘pre-disclosure consultation, has been little studied. Objec-tive: To determine the content of the ‘pre-disclosure’ consultation carried out by GPs in practice. Method. A retrospective quantitative study was conducted using a questionnaire among GPs who referred pa-tients who had a cancer disclosure consultation between 1 October and 31 December 2017 in Toulouse, France. The online questionnaire comprised 34 closed-ended questions and one open-ended question. Data analysis was descriptive. Results. Of the 174 patient records selected, corresponding to 174 different GPs, 81 GPs responded. Fifty-four had carried out a ‘pre-disclosure’ consultation (89% lasting more than 15 minutes, 26% more than 30 minutes). Half mentioned supportive care; almost all considered it helpful for coming to terms with the illness, and 85 per cent limited the information in order to deliver the news in stages. Conversely, 27 of the GPs had not given a ‘pre-disclosure’, half of whom would have liked to have done so Conclusion. The ‘pre-disclosure’ is carried out informally. GPs take the time to organise this consultation and tailor it to the patient. However, a lack of information and the isolation of GPs complicate the ‘pre-disclosure’. Integrating it into the disclosure process could improve the coordination of care. Structuring the ‘pre-disclosure’ using appropriate tools and providing better support for GPs is necessary to support patients.

Studies in the United States, Canada, Belgium, and Switzerland showed that the majority of health problems are managed within primary health care; however, the ecology of French medical care has not yet been described. Nationwide, population-based, cross sectional study. In 2018, we included data from 576,125 beneficiaries from the General Sample of Beneficiaries database. We analysed the reimbursement of consultations with (i) a general practitioner (GP), (ii) an outpatient doctor other than a GP, (iii) a doctor from a university or non-university hospital; and the reimbursement of (iv) hospitalization in a private establishment, (v) general hospital, and (vi) university hospital. For each criterion, we calculated the average monthly number of reimbursements reported on 1,000 beneficiaries. For categorical variables, we used the χ² test, and to compare means we used the z test. All tests were 2-tailed with a P-value < 5% considered significant. Each month, on average, 454 (out of 1,000) beneficiaries received at least 1 reimbursement, 235 consulted a GP, 74 consulted other outpatient doctors in ambulatory care and 24 in a hospital, 13 were hospitalized in a public non-university hospital and 10 in the private sector, and 5 were admitted to a university hospital. Independently of age, people consulted GPs twice as much as other specialists. The 13–25-year-old group consulted the least. Women consulted more than men. Individuals covered by complementary universal health insurance had more care. Our study on reimbursement data confirmed that, like in other countries, in France the majority of health problems are managed within primary health care.