Since the beginning of the century, the USA have been experiencing an opioid epidemic characterised by high levels of prescription opioid use. While extensive North American literature on the topic has been published and several public health measures implemented attempting to address the problem, in Europe addiction research, especially literature focusing on misuse of medicines, lags far behind. France is an exception: it is the only European country that has established a nationwide specific system to monitor misuse of legal and illegal psychoactive substances, an activity that has been named addictovigilance. Thanks to the combined use of several data sources, the French addictovigilance system has, in its three decades of existence, proven to be effective in the early identification and assessment of addictovigilance signals, providing real-world evidence to support the conception and monitoring of public health measures to minimise the health risks posed by psychoactive substance misuse in France.