Morphine is the key medication for managing severe pain, especially in patients requiring palliative care. Despite regulatory changes aimed at improving access to opioid analgesics, Morphine remains underused in primary healthcare. Exploring physicians’ awareness and the barriers to its prescription is crucial to improving pain management practices.To assess the frequency of morphine prescription and the level of awareness among primary care physicians regarding standard practices and recent regulatory changes.A quantitative cross-sectional study was conducted using an online questionnaire (Google Forms). A total of 107 physicians from all regions of the Kyrgyz Republic participated. Most respondents were family doctors (N = 89), with general practitioners also represented (N = 13). The survey collected information on demographics, professional status, knowledge of the WHO pain ladder, morphine prescribing practices, and awareness of Government Decree No. 572 (dated 8 September 2025), which regulates the prescription of narcotic and psychotropic drugs. (Descriptive statistics were used for data analysis)The mean age of respondents was 46.5 ± 12 years, with 98 women. Although 86 reported being familiar with the WHO pain ladder, only 16 prescribed Morphine, mostly rarely or monthly. The main reasons for not prescribing Morphine were absence of patients requiring it (63/84), fear of responsibility (11/84), and insufficient knowledge (10/84). 62 respondents reported having only partial knowledge of practical guidance on Morphine use. Notably, 38 physicians were unfamiliar with the new Decree No. 572, and an additional 33 were only partially familiar with its content. The most frequently cited concerns were potential side effects (48) and risk of patient addiction (37). When Morphine was unavailable, 80 relied on non-opioid analgesics.The findings reveal a significant gap between physicians’ theoretical awareness and practical use of Morphine. Despite the updated legal framework, concerns, lack of training, and limited access to clear clinical guidance remain major barriers.To improve access to adequate pain relief in primary care, targeted educational initiatives, better dissemination of regulatory updates, and the development of practical clinical guidelines for family doctors are essential.

Osteoarthritis is a common joint disease causing chronic pain and impaired quality of life. Given the limitations of conventional therapies (NSAIDs, analgesics, non-drug treatments), marine collagen, a natural nutraceutical, has gained growing interest for its potential effects on joint pain.This narrative review aims to summarize available experimental studies about the effects of marine collagen hydrolysates on osteoarthritic joints, focusing on tolerance, joint pain and mobility, on joint cells, inflammatory mediators, and cartilage structure.A narrative literature review was conducted using PubMed, Scopus, and the Cochrane Library, along with grey literature analysis. Included studies assessed supplementation with marine-derived collagen in osteoarthritis or joint pain. Among 438 articles, 16 experimental studies were retained including 6 clinical and 10 preclinical studies.Clinical studies generally reported reduced joint pain and improved joint function, with good overall tolerance of marine HC. Safety appeared well-established, with no evidence of pathogen transmission. Preclinical studies (in vivo and in vitro, using human or animal models) highlighted beneficial effects on cartilage matrix integrity, inflammatory mediators, and biomarkers. However, two of the preclinical studies, mainly conducted ex vivo, have shown paradoxical effects, depending on hydrolysate fraction size and concentration.Clinical results are encouraging but heterogeneous ; as tested products were extracted from different, not always comparable, sources. Studies also differed in analytical methods and methodological quality. Some preclinical studies showed variable results, depending on hydrolysate concentration, source, and extraction method. Although ex vivo findings have limited clinical transposability, they suggest that the effects of one hydrolysate preparation cannot be extrapolated to others. Therefore, defining a HC as a safe and effective nutraceutical requires thorough evaluation of its pleiotropic effects.The available data do not yet allow firm conclusions regarding the specific efficacy of all marine HC in osteoarthritis. Nevertheless, this review highlights preliminary biological and clinical evidence suggesting potential benefits in certain cases. Well-designed randomized, double-blind clinical trials with standardized formulations, defined populations, and long-term follow-up are required to confirm efficacy, safety, and indications.

In France, secured prescriptions have been mandatory  since 2000 for drugs classified as narcotics. In response to increasing reports of abuse, misuse and dependence, secured prescription requirement were extended to zolpidem in 2017 and to pregabalin in 2021.This study aimed to assess the impact of these secured prescription requirements on the dispensing of zolpidem and pregabalin in France between 2014 and 2024.We conducted an observational, cross-sectional study, using Open Medic, an open-access annual database providing reimbursement information on drugs dispensed in pharmacies. The study population included all patients dispensed zolpidem or pregabalin in France between January 1, 2014, and December 31, 2024.. The primary outcome was the annual number of zolpidem and pregabalin packages dispensed. Stratified analyses were performed according to age group, gender and prescriber specialty. Negative control drugs not requiring secured prescriptions (zopiclone and gabapentin) were included for both substances to assess potential substitution.Between 2014 and 2024, the number of zolpidem packages dispensed in France decreased from 19,812588 to 5,780,872 (-70%) with the largest decline occurring between 2016 and 2018. In comparison, zopiclone dispensing increased during this period, mirroring the decrease in zolpidem, although to a lesser extent (+21% between 2016 and 2018). For pregabalin, the number of packages increased between 2014 and 2020 (+28%), followed by a decline until 2024 (-29%) resulting in fewer packages dispensed in 2024 than in 2014. Gabapentin dispensing increased between 2014 and 2020 (+28%), with a more pronounced rise from 2020 to 2024 (+50%), coinciding with the introduction of secured prescription requirements for pregabalin.The temporary increase in zopiclone dispensing contrasts with the continued rise in gabapentin, which may be explained by the 2021 recommendation designating gabapentin as a first-line treatment for neuropathic pain. Overall, the secured prescription measure appears to be effective in the long term. Clonazepam, which has required secured prescriptions since 2011, also showed a continuous decrease in dispensing over time, with a 31% reduction over 10 years.The introduction of secured prescription requirements resulted in a reduction in zolpidem and pregabalin dispensing with limited substitution to alternative drugs.

In 2019, France launched a national pilot program to introduce medical cannabis for selected indications, such as refractory neuropathic pain or intractable symptoms in oncology, under the supervision of the French National Agency for Medicines and Health Products Safety (ANSM). Prescribing was initially restricted to referral centers, with the possibility of continuation by general practitioners (GPs). However, uptake of medical cannabis prescribing in primary care has remained limited.The primary objective was to explore the factors influencing GPs’ decisions to potentially prescribe, or not prescribe, cannabis.Our study used a design with semi-structured interviews, followed by a grounded analysis. Participants were GPs practicing in primary care in Occitanie, including both physicians involved in the national pilot program and those who were not prescribers. Analysis followed an iterative comparative process with coding and theme development until thematic saturation reached.Medical cannabis generated significant expectations among participants, particularly regarding pain relief in situations where conventional treatments had failed and as a potential means to reduce opioid analgesic use. Clinical judgment was constructed through training and review of the scientific literature, but above all through feedback from treated patients, which played a central role in influencing prescribing attitudes.The perceived analgesic benefit of medical cannabis remains insufficiently demonstrated in the current literature, which echoes participants’ simultaneous hope and doubt. Future prescribing frameworks in France will need to take into account existing difficulties in accessing specialist care, which may limit the feasibility of highly specialized prescribing models. In this context, international experiences and established national prescribing pathways may provide useful guidance. Although the risk of dependence and misuse is more clearly documented for recreational cannabis, participants considered these risks relevant in medical use as well, supporting the need for regulatory and monitoring measures accompanying anyGPs’ acceptance of medical cannabis appears to rely on a balance between expected therapeutic benefit and concerns. These findings highlight the importance of scientific evidence, appropriate regulation, and education to support the future integration of medical cannabis into primary care practice.

Since 2021, France has been conducting an experiment with medical cannabis under the auspices of the ANSM, involving general practitioners and hospital doctors, community and hospital pharmacists, and patients. After completing training, professionals are authorized to prescribe and dispense medical cannabis to treat refractory neuropathic pain, painful spasticity, refractory and drug-resistant epilepsy, palliative situations, and intractable symptoms in oncology.This experiment has already given rise to several studies, mainly theses by medical interns, focusing on obstacles, facilitators, and representations. This research, conducted in partnership with the ANSM, remains above all pragmatic in order to make empirical observations about the experiment.This study aims to show that a psychosocial approach can shed light on the mechanisms underlying the results targeted by medical cannabis trials.It uses a qualitative secondary analysis method applied to a large existing corpus: 194 semi-structured interviews and 8 focus groups conducted by interns as part of their general medicine theses. The homogeneous sample includes healthcare professionals and patients involved in the trial. The phenomenologically inspired analysis consists of a sociopsychological re-reading of these materials in order to examine how medical cannabis influences identities, standards of care, and the place of this subject at the intersection of medicine, politics, and lived experience.The results, currently being compiled, should show that concepts from social psychology and sociology - identity, norms, representations, social roles, boundary objects - can reveal the multidimensional issues at stake in this experiment, whether medical, political, identity-related, normative, or representational.The general hypothesis is that the experiment goes beyond the simple introduction of a new treatment: it reveals tensions between knowledge, norms, and identities in the field of health, reconfigures social roles, brings about new identity affiliations, and forces actors to negotiate meanings in an uncertain symbolic space.To our knowledge, no study has addressed experimentation from a psychosocial perspective, even though it is not limited to therapeutic innovation: it acts as a vector of social transformation within the health field.

The consumption of outpatient medications continues to grow in France. This can lead to adverse drug reactions (ADRs), some of which are predictable and preventable. But it also carries a risk of iatrogenic medication, which is the cause of morbidity, mortality and high healthcare costs. This is a major challenge as it is the second leading cause of serious preventable adverse events in healthcare.The objective of this study was to estimate the prevalence of medication-related causes of complaints reported during consultations among adult patients in the Ile-de-France region in 2024.This was an observational, non interventional, cross-sectional, descriptive, quantitative study using a completely anonymous questionnaire administred to patients over the age of 18 in the Ile-de-France region. The questionnaires were completed retrospectively by four different investitagors, all of whom were general medicine interns at Sorbonne Paris Santé University.We analyzed a total of 1000 patient prescriptions. Of these, 105 (10.5%, 95% CI : 9-11%) came to see us for a reason identified by our approach as a possible adverse drug reaction. The most frequently implicated drug class was antihypertensives (28,5% n=51). Patients with potential ADRs consumed significantly more drugs, were generally older and more drug interactions in their prescriptions. Finally, using a logistic regression model, we found that advanced age significantly increased the risk of potential ADRs in patientsaged 50-65 (OR : 5.47 p-value < 0.022) and aged 66-80 (OR : 6.63 p-value < 0.013), while polypharmacy significantly increased this risk by 14% (p< 0,008).Factors that could influence the occurence of these adverse drug reactions were : polypharmacy, advanced age and drug interactions. Our approach to detecting adverse effects is part of quaternary prevention to enrich our prescribing practices and reinforce actions promoting the proper use of medications and coordination between prescriptions from different healthcare professionals.General practitioners are experts on their patients. This has enabled us to identify areas for improvement in our practice with regard to polypharmacy and drug interactions particularly among our oldest patients.

Opium extract-based medications (Lamaline® and Izalgi®) are opioid analgesics classified as level 2 according to the World Health Organization (WHO). In the context of proper use of analgesics, especially opium derivatives, and considering the issues raised globally, it is important to question their usage.This work wanted to evaluate the effectiveness of these opium extracts in primary care.This is a systematic review of the literature to assess the effectiveness of opium extract (Lamaline®, Izalgi®) in pain management regardless of its origin. This review adhered to PRISMA guidelines. The bibliographic search was conducted until 18/07/2024 in the four main databases (Medline - PubMed, Embase, Cochrane Central Register of Controlled Trials - CENTRAL, and ClinicalGov.org) using the following MeSH terms: “opium extract,” “opium powder,” “lamaline,” or “izalgi.”The bibliographic search led to the inclusion of a single phase III multicenter, randomized, double-blind, non-inferiority trial. The analysis of this trial using the Rob2 tool identified a risk of bias. According to the REB method, there is no evidence of effectiveness of the use of opium extract in pain relief.There appears to be a lack of published data on the use of opium-extract analgesics. Therefore, in the era of evidence-based medicine (EBM), it is legitimate to question the prescription of analgesics such as opium derivatives due to the lack of solid data demonstrating their effectiveness. This study did not identify sufficient evidence (whether convincing or not) to recommend the prescription of Izalgi® or Lamaline® for any type of pain, particularly considering their side effects.These results justify reconsidering the prescription of opium extracts for pain management. High quality clinical trials are needed to provide a solid level of evidence for the effectiveness of opium exract in pain treatment.