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Gomes T, Juurlink D, Yao Z, et al. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis. CMAJ Open. 2014;2(4):E256-61doi: 10.9778/cmajo.20140027.
Gomes, T., Juurlink, D., Yao, Z., Camacho, X., Paterson, J. M., Singh, S., Dhalla, I., Sproule, B., & Mamdani, M. (2014). Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis. CMAJ open, 2(4), E256-61. https://doi.org/10.9778/cmajo.20140027
Gomes, Tara, et al. "Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis." CMAJ open vol. 2,4 (2014): E256-61. doi: https://doi.org/10.9778/cmajo.20140027
Gomes T, Juurlink D, Yao Z, Camacho X, Paterson JM, Singh S, Dhalla I, Sproule B, Mamdani M. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis. CMAJ Open. 2014 Oct 01;2(4):E256-61. doi: 10.9778/cmajo.20140027. eCollection 2014 Oct. PMID: 25485251; PMCID: PMC4251507.
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CMAJ Open. 2014 Oct 01;2(4):E256-61. doi: 10.9778/cmajo.20140027. eCollection 2014 Oct.

Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis.

CMAJ open

Tara Gomes, David Juurlink, Zhan Yao, Ximena Camacho, J Michael Paterson, Samantha Singh, Irfan Dhalla, Beth Sproule, Muhammad Mamdani

Affiliations

  1. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ont. ; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
  2. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Sunnybrook Research Institute, Toronto, Ont. ; Department of Medicine, University of Toronto, Toronto, Ont.
  3. Institute for Clinical Evaluative Sciences, Toronto, Ont.
  4. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ont. ; Department of Family Medicine, McMaster University, Hamilton, Ont.
  5. Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Department of Medicine, St. Michael's Hospital, Toronto, Ont. ; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
  6. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont. ; Department of Psychiatry, University of Toronto, Toronto, Ont. ; Centre for Addiction and Mental Health, Toronto, Ont.
  7. Department of Medicine, St. Michael's Hospital, Toronto, Ont. ; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ont. ; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.

PMID: 25485251 PMCID: PMC4251507 DOI: 10.9778/cmajo.20140027

Abstract

BACKGROUND: The increased use of opioid analgesics, sedative hypnotics and stimulants, coupled with the associated risks of overdose have raised concerns around the inappropriate prescribing of these monitored drugs. We assessed the impact of new legislation, the Narcotics Safety and Awareness Act, and a centralized Narcotics Monitoring System (implemented November 2011 and May 2012, respectively), on the dispensing of prescriptions suggestive of misuse.

METHODS: We conducted a time series analysis of publicly funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly in Ontario from January 2007 to May 2013, based on information in the Ontario Public Drug Benefit Database. In the primary analysis, a prescription was deemed potentially inappropriate if it was dispensed within 7 days of an earlier prescription and was for at least 30 tablets of a drug in the same class as the earlier prescription, but originated from a different physician and a different pharmacy.

RESULTS: After enactment of the new legislation, the prevalence of potentially inappropriate opioid prescriptions decreased by 12.5% in 6 months (from 1.6% in October 2011 to 1.4% in April 2012; p = 0.01). No further significant change was observed after the introduction of the narcotic monitoring system (p = 0.8). By May 2013, the prevalence had dropped to 1.0%. Inappropriate benzodiazepine prescribing was significantly influenced by both the legislation (p < 0.001) and the monitoring system (p = 0.05), which together reduced potentially inappropriate prescribing by 50.0% between October 2011 and May 2013 (from 0.4% to 0.2%). The prevalence of potentially inappropriate prescribing of stimulants was significantly influenced by the introduction of the monitoring system in May 2012, falling from 0.7% in April 2012 to 0.3% in May 2013 (p = 0.02).

INTERPRETATION: For a select group of drugs prone to misuse and diversion, legislation and a prescription monitoring program reduced the prevalence of prescriptions suggestive of misuse. This suggests that regulatory interventions can promote appropriate prescribing which could potentially be applied to other jurisdictions and drugs of concern.

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