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RESUME Contexte : La consommation des substances controlees et plus particulierement des opioides est un enjeu de sante publique. Le Canada se situe au deuxieme rang des plus gros consommateurs d’opioides dans le monde. L’utilisation de ces substances est associee a des problemes de mesusage. A preuve, une crise des opioides sevit en Amerique du Nord. Objectifs : Decrire et analyser les tendances de consommation des substances controlees au sein d’un etablissement de sante de 2003-2004 a 2017-2018. Proposer un outil de surveillance de la consommation des substances controlees dans un etablissement de sante. Methodologie : Etude descriptive retrospective. A partir du logiciel de gestion des approvisionnements, nous avons extrait les donnees de consommation de toutes les substances controlees du 1er avril 2003 au 31 mars 2018. Les donnees ont ete exprimees selon l’index de la classification Anatomical Therapeutic Chemical en nombre de doses definies journalieres (DDJ) pour 1000 jours-presence avec les valeurs de DDJ proposees par l’Organisation mondiale de la sante. Seules des statistiques descriptives ont ete effectuees. Resultats : Durant les 15 dernieres annees, la consommation des substances controlees a diminue de 43 % au sein de notre etablissement (min. : 739; max. : 1292 DDJ/1000 jours-presence par annee). De 2003- 2004 a 2017-2018, les principales classes therapeutiques consommees par ordre decroissant etaient : opioides, hypnotiques et sedatifs, anxiolytiques et anesthesiques generaux. Les principales molecules opioides consommees en 2017-2018 sont l’hydromorphone et la morphine injectable. Conclusions : Cette etude descriptive retrospective montre une diminution de la consommation des substances controlees au sein de notre etablissement de 2003-2004 a 2017-2018. Elle demontre la faisabilite de developper un outil de surveillance de la consommation des substances controlees en etablissement de sante. Une telle approche pourrait etre implantee a large echelle afin de favoriser les comparaisons entre les etablissements. ABSTRACT Background: The use of controlled substances, especially opioids, is a public health concern. Canada is the country with the second greatest opioid use in the world. The use of these substances is associated with problems of misuse, as evidenced by North America’s opioid crisis. Objectives: To describe and analyze usage patterns for controlled substances in a health care facility from 2003/04 to 2017/18, and to propose a tool for monitoring the use of controlled substances in this setting. Method: In this retrospective descriptive study, usage data for all controlled substances were extracted from the institution’s supply management software for the period April 1, 2003, to March 31, 2018. The data are presented according to the Anatomical Therapeutic Chemical classification in terms of number of Defined Daily Doses (DDD) per 1000 inpatient-days, using the DDD values proposed by the World Health Organization. Only descriptive statistics were determined. Results: During the last 15 years, use of controlled substances at the study facility dropped by 43% (min. 739 and max. 1292 DDD/1000 inpatient-days per year). From 2003/04 to 2017/18, the main therapeutic classes consumed (in decreasing order) were opioids, hypnotics and sedatives, anxiolytics, and general anesthetics. The main opioid molecules consumed in 2017/18 were hydromorphone and injectable morphine. Conclusions: This retrospective descriptive study showed a decrease in the consumption of controlled substances in the study facility from 2003/04 to 2017/18. It also demonstrated the feasibility of developing a tool for monitoring the use of controlled substances in a health care facility. This approach could be implemented at a larger scale to foster comparisons between facilities.

Surveillance des substances contrôlées en établissements de santé : une contribution à la gestion de la crise des opioïdes au Canada