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Legislation significantly decreased potentially inappropriate drug prescriptions

Toronto, November 18, 2014

By Geoff Koehler

Tara Gomes
Tara Gomes

Prescription rates for frequently misused drugs were dramatically reduced in Ontario by policy interventions designed to monitor the prescribing of these drugs, according to new research.

The prevalence of potentially inappropriate opioid, benzodiazepine and stimulant prescriptions in Ontario fell by 40 per cent, 58 per cent and 60 per cent, respectively, after legislation and a centralized prescription monitoring system was implemented.

“Every year, thousands of Canadians die of drug overdoses from misused prescription drugs such as opioids, benzodiazepines and stimulants,” said lead author Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. “This led to increasing concern among Ontario physicians and public health officials.”

Ontario passed the Narcotics Safety and Awareness Act in November 2011. The act required physicians to identify themselves by name and their licensing body’s registration number on prescriptions for all narcotics and other controlled substances dispensed in the province. This legislation also mandated the development of the Narcotics Monitoring System, which was launched in May 2012.

The Narcotics Monitoring System records prescriber, pharmacist and patient information for all dispensed narcotics and other controlled drugs. The system also alerts pharmacists when they’re dispensing prescriptions about potentially inappropriate drug-seeking behavior, such as conflicting filled prescriptions or other pharmacies that have dispensed a prescription.

The study, published today in CMAJ Open, evaluated the impact the Narcotics Safety and Awareness Act and the Narcotics Monitoring System had on the rate of dispensing of monitored drugs among public drug plan beneficiaries in Ontario.

“The Narcotics Monitoring System is a tool for healthcare providers to monitor potentially inappropriate prescriptions,” said Gomes. “However, only pharmacists currently have access to this system. The value of this system could be greatly improved by expanding access to physicians to help them understand patients’ prescribing history and identify potential drug-seeking behavior at the time of writing a prescription.”

Researchers looked at publicly funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly from January 2007 to May 2013. The 6.5-year study period included months before and after the Narcotics Safety and Awareness Act was implemented.

Gomes found that more than 70 million prescriptions for monitored drugs were dispensed during the study period – almost one million of which were deemed highly likely to represent inappropriate prescribing.

“Our study shows legislation can have a powerful impact on reducing harmful prescribing patterns but it’s important to recognize that these recent policies, haven’t solved the problem,” said Gomes. “In 2013, we still found that approximately one out of every 100 prescriptions for opioids was potentially inappropriate.”

Researchers deemed a prescription potentially inappropriate if it was refilled early — within seven days of an earlier prescription for at least 30 tablets of a drug in the same class – and originated from a different physician and different pharmacy.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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