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

Gomes, Tara; Juurlink, David N.; Zhang, Yao; Camacho, Ximena; Jm, Paterson; Singh, Surinder; Dhalla, Irfan A.; Sproule, Beth; Mamdani, Muhammad

doi:10.9778/cmajo.20140027

Cited by 68 publications

(85 citation statements)

References 7 publications

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“…Outside of the United States, several countries have implemented PMPs that are associated with reductions in potentially problematic prescribing; however, their impact on benzodiazepine safety (e.g., ED visits) is unclear (Gomes et al, 2014; Pradel et al, 2009; Dormuth, Miller, Huang, Mamdani, & Juurlink, 2012; Islam & McRae, 2014). As morbidity and mortality related to benzodiazepines has increased, urgent investigation is needed to identify PMP structures and capabilities, as well as other potential policy interventions, to improve prescribing safety.…”

Section: Discussionmentioning

confidence: 99%

Prescription monitoring programs and emergency department visits involving benzodiazepine misuse: Early evidence from 11 United States metropolitan areas

Bachhuber

Maughan

Mitra

et al. 2016

International Journal of Drug Policy

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Background Emergency department (ED) visits involving benzodiazepines have increased in the United States. Most states have created prescription monitoring programs (PMPs) to improve drug prescribing safety. To determine the association between PMP implementation and ED visits involving benzodiazepine misuse, we conducted a retrospective analysis of data from 11 metropolitan areas in the United States from 2004 to 2011. Methods We estimated rates of ED visits per 100,000 residents involving benzodiazepine misuse from the Drug Abuse Warning Network dataset. Dates of PMP implementation were obtained from program administrators. We used linear regression models to assess whether PMP implementation was associated with a change in ED visits involving benzodiazepines. Models were adjusted for calendar quarter, metropolitan area, and metropolitan area-specific linear time trends. Results Rates of ED visits involving benzodiazepine misuse increased in all metropolitan areas during the study period. PMP implementation was not associated with a change in ED visits (mean difference: 0.9 [95% CI: −0.09 to 1.9] visits per 100,000 population per quarter; p=0.08). When analyzed by number of years after implementation, PMPs were associated with a higher visit rate in year one (0.8 [95% CI: 0.2 to 1.5]; p = 0.01]), but not in year two (0.3 [95% CI: −2.1 to 2.8]; p = 0.78) or year three or later (2.1 [95% CI: −0.4 to 4.7]; p = 0.10). Conclusion We did not find evidence that PMP implementation was associated with reductions in ED visits involving benzodiazepine misuse. Future work should identify PMP features and capabilities that improve benzodiazepine safety.

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Section: Discussionmentioning

confidence: 99%

Prescription monitoring programs and emergency department visits involving benzodiazepine misuse: Early evidence from 11 United States metropolitan areas

Bachhuber

Maughan

Mitra

et al. 2016

International Journal of Drug Policy

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“…For example, Gomes and others 15 include figures in their paper that help illustrate the effect of new narcotics legislation on the prevalence of opioid, benzodiazepine, and stimulant prescriptions that would have triggered warnings of "double-doctoring" and polypharmacy.…”

Section: Prescribing and Dispensing Patternsmentioning

confidence: 99%

“…Efforts are underway to improve data capture, e.g., through the Narcotics Monitoring System in Ontario. 15 As more provinces move toward capturing all drugs for all residents, it will become easier to comprehensively assess and compare drug use and effects.…”

Section: Prescribing and Dispensing Patternsmentioning

confidence: 99%

An Introduction to Health Care Administrative Data

Cadarette

Wong

2015

CJHP

121

124

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“…[14][15][16][17] In 2013, a national strategy to provide a "roadmap for reducing the harms associated with [prescription drugs] while giving important consideration to their therapeutic uses" was released and presented a list of (largely complex or vague) recommendations; however, it is not clear how many have been effectively implemented. 18 Federal regulators presented draft regulations in 2015 to require a tamper-proof design for prescription opioids; however, it was limited to oxycodone formulations only, which accounted for about 10% of dispensed opioids.…”

Section: Past Interventions Ineffectivementioning

confidence: 99%

Effective Canadian policy to reduce harms from prescription opioids: learning from past failures

Fischer

Rehm

Tyndall

2016

CMAJ

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Analysis• Canada has been facing a major public health crisis of prescription opioid−related morbidity and deaths.• Several -largely narrow and reactive in scope -interventions have been implemented since 2010, yet, they have remained ineffective in curtailing morbidity and deaths.• Overall amounts and patterns (e.g., high dose) of prescription opioids dispensed are primary causal drivers of population-level morbidity and mortality.• Authorities should urgently implement effective (e.g., enforceable guidelines with use/dose restrictions) evidence-based measures to reduce overall amounts of opioid dispensing and thus harms.

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

Cited by 68 publications

References 7 publications

Prescription monitoring programs and emergency department visits involving benzodiazepine misuse: Early evidence from 11 United States metropolitan areas

Prescription monitoring programs and emergency department visits involving benzodiazepine misuse: Early evidence from 11 United States metropolitan areas

An Introduction to Health Care Administrative Data

Effective Canadian policy to reduce harms from prescription opioids: learning from past failures

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