Paracetamol, fentanyl, morphine... What are the drugs whose production will be relocated to France?

The ambition is strong and the stakes in terms of public health are essential. In order to deal with the shortage of certain drugs which has affected France for several months, the President of the Republic Emmanuel Macron announced on Tuesday that no less than 50 of the 450 drugs deemed "essential" would see their production lines repatriated to France in the next few years, because of our excessive dependence on important non-European countries. See “in the coming weeks” for an even more precise list of drugs.

“We must absolutely continue to relocate the raw material or the finished product, and sometimes both, to secure the supply of stocks in the territory”, launched the Head of State on Tuesday, specifying that “within these 450 , there is a core list” of drugs, for which “diversifying” or “duplicating our supply chains is not enough”. "We must relocate", he hammered, announcing that "of the first fifty essential medicines for which our dependence on imports from outside Europe is proven, half - 25 of them - will see their production relocated or increased significantly on the national territory in the weeks to come".

Among these 25 drugs, there is amoxicillin, a commonly used antibiotic indicated in the case of many bacterial infections (angina, kidney, lung, joint, heart, dental infections, etc.) and ciprofloxacin, a broad-spectrum antibiotic. spectrum used in particular in the treatment of urinary, intestinal and pulmonary infections. There are also a number of drugs used in resuscitation and emergency, such as paracetamol indicated in the management of weak to intense pain, morphine, this painkiller used in the management of intense pain, chronic and acute, including cancer pain.

But also fentanyl, an analgesic used in the management of intense chronic pain (cancer), post-operatively and during anesthesia, propofol, indicated in general anesthesia or sedation during hospitalizations, midazolam , used in the management of convulsions in children (oral route) and in the management of anesthesia and sedation (injection route). Still among these drugs used in emergency, there is also diazepam, used in particular in the management of anxiety, convulsions in children, and epilepsy, as well as clonazepam, indicated in epilepsy and Lennox-Gastaut syndrome.

There are also three curares used in intensive care units, as an adjuvant to sedation, or general anesthesia, as well as in the case of curarization: rocuronium, cisatracurium and suxamethonium. Two last drugs are mainly used for emergencies: adrenaline, used in intensive care and noradrenaline, used in the management of collapse and gastrointestinal bleeding.

In this list, there are also five drugs "used in the management of chronic conditions affecting a large population", such as methylprednisolone, used mainly for its anti-inflammatory effect, in the management of more than fifty chronic conditions , ranging from asthma to cancers, esomeprazole, used in the management of many gastric conditions, ranging from inflammation to ulcers, furosemide, a diuretic used alone in the management of hypertension, insufficiency kidneys, or oedemas, in chronic and emergency cases, clopidogrel, used in the management of thrombolytic accidents as well as salbutamol, used in pulmonology and gynecology.

And finally, six anti-cancer drugs appear on this list: topotecan, indicated in the case of certain lung cancers and of the female genital system (ovary, uterus), melphalan, used in the management of certain blood cancers and female cancers (ovary, breast), busulfan, used in the context of blood cancers (leukaemia), and in the conditioning of bone marrow transplants, fludarabine, used in the treatment of certain blood cancers, paclitaxel, indicated mainly in the management of breast and ovarian cancers, and certain lung cancers as well as oxaliplatin, indicated in several colorectal cancers.

So many drugs whose production will be relocated or reinforced urgently, not because they are more important than the others, but because they are the ones that are most subject to "out of stock", produced outside European borders. Because the announcement of the President of the Republic comes when the year 2022 has been marked by many shortcomings. In total, more than 3,500 molecules were out of stock or at risk of being out of stock last year. According to the BVA study carried out for France Assos Santé in March 2023, 37% of French people have been faced with shortages in pharmacies, underlines the Elysée. And the situation should remain tense for a while, warned the head of state: "we will still have emergency situations in the coming months and years," he also warned.

A situation confirmed by Pierre-Olivier Variot, pharmacist in Plombières-lès-Dijon and president of the Union of Community Pharmacists (USPO). “All medicines are important, and it is not because a medicine is less dispensed, because it responds to a rarer pathology, that it is less important”, launches this professional in the sector, who confirms “ having terribly lacked medicines this winter”, in particular essential medicines to treat “infections and inflammations”. An “unacceptable” situation when “more than 3000 molecules are out of order” according to him. “Who am I to say which of these 3000 molecules are more important than others?” he asks.

“Drugs are not consumer goods, when we talk about drugs, we are talking about care pathways”, he continues, taking the example of this anti-cancer drug which he receives in extremely limited quantities and which he is never sure to receive the following month. “I have a cancer patient, who needs a box a month of his out-of-stock medication. Every month, I fight to get his box, but I can't promise him anything because I'm not sure I'll receive any next month", he testifies, before affirming that there is for a short time, he only had to order this medicine two or three days in advance, whereas today the deadline has increased to three weeks. So much so that he spends 12 hours a week looking for drugs that are out of stock. Concretely, “every morning, someone from my team or myself, we call the wholesalers or the laboratories to find them”, assures Pierre-Olivier Variot. Before launching: "I'm terribly afraid of the next winter".