The flunitrazepam abuse prevention program at a general hospital in Taiwan: A descriptive study*

Abstract

The Bureau of Controlled Drugs at Ministry of Health, Executive Yuan in Taiwan All prescription data were divided into three 4 month periods: period I was when the flunitrazepam prescription was not controlled, period II represented the time when flunitrazepam was placed on Schedule III and when physicians were required to use a special duplicated prescription form and period III was when the TMU-WFH started to set a stricter control for the prescription of flunitrazepam. The results indicated that the number of flunitrazepam prescriptions during period III had decreased significantly compared with period I (P £ 0.05). Eventually, 45.7% of flunitrazepam-medicated patients were followed up monthly with a restriction of their flunitrazepam supply to no more than 14 days, 22.9% of patients were followed up fortnightly at clinics with a 14 day supply of flunitrazepam, 15.7% were followed up fortnightly with a 14 day restriction of flunitrazepam plus a non-flunitrazepan benzodiazepine supplement, 10.7% were referred to clinics within the Department of Psychiatry and 5% were switched from flunitrazepam to other drugs. Like most BZD, flunitrazepam produces five physiologic (anxiolytic, sedative, anticonvulsant, musclerelaxing and amnestic) functions. 1 Usually, there is no life-threatening outcome of overdose with flunitrazepam alone because it acts only on BZD GABA A (or simply benzodiazepine) receptors in the central nervous system. 1 However, flunitrazepam has the potential to be fatal if coadministered with alcohol, which acts directly on chloride ion channels. 1,5 Flunitrazepam readily dissolves and, once in solution, is colorless, odorless and tasteless. 5,6 Victims are vulnerable to sexual assault when flunitrazepam is administered in an alcoholic drink; therefore, flunitrazepam is widely abused as a drug in date rape or acquaintance rape scenarios. 3,7 Before 1 April 2000, all BZD were easily obtained from any drugstore in Taiwan. However, the Bureau of Controlled Drugs of Ministry of Health, Executive Yuan classified all BZD as Schedule IV drugs (Table 1), 8 with the exception of three BDZ (brotizolam, triazolam and flunitrazelam), which were specifically placed on Schedule III. 8 Of these three BZD, only flunitrazepam is available from the formulary in the Department of Pharmacy at Taipei Medical University-Wan Fang Hospital (TMU-WFH). Only 2 mg flunitrazepam pills are available at the TMU-WFH. According to Government policy, a prescribing physician needs to register with the Bureau for a prescribing license and fills out a duplicate prescription sheet when he/she prescribes any controlled drug on Schedules I-III. 8 To abide by the new policy of the Bureau of Controlled Drugs, the Committee of Controlled Drugs was founded at TMU-WFH in the summer of 2000. The Committee assumed the task of hospital-wide education and in-service training for physicians and related clinical disciplines (nurses, physicians' assistants, pharmacists etc.) about the classification of scheduled drugs (Table 1) and the regul...

Party Drugs: Properties, Prevalence, Patterns, and Problems

“…A duplicate prescription sheet was required and it could only be filled in the Department of Pharmacy at Taipei Medical University-Wan Fang Hospital. The number of flunitrazepam pills prescribed dropped from 33,610 in the quarter June 2000 through September 2000 to 12,108 in the quarter February 2001 through May 2001 (Shen et al, 2002).…”

A systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders

“…With 7 studies conducted in Australia and New Zealand, Oceania was also strongly involved in combating SH misuse [ 38 , 41 , 62 – 66 ]. Only 1 study was conducted in Asia [ 67 ].…”

“…The impact of regulatory interventions such as restriction of SH prescription conditions was assessed in 8 studies [ 45 , 47 , 50 , 53 , 55 , 56 , 58 , 67 ]. Regulatory strategies were managed by national or local authorities and were directed toward physicians.…”

“…Positive results were reported in 7 out of the 8 studies assessing regulatory interventions [ 45 , 47 , 50 , 55 , 56 , 58 , 67 ]. Ending of reimbursement and restriction of prescription rules were presented as effective strategies to reduce the prescription and/or the consumption of targeted SHs (up to 85%).…”

Pilotstudie zur Rezeptierung von Benzodiazepinen in der Schweiz: Beeinflusst die kognitive Verfügbarkeit von Gesetzesvorschriften das ärztliche Verschreibungsverhalten?

“…Die iatrogene (Mit-)Verursachung von Benzodiazepinabhängigkeit hat für die Suchtprävention eine entscheidende Bedeutung [14,15], wenngleich der Kausalnachweis iatrogener Verursachung oft schwierig ist [16]. Weil die Berufsgruppen der ¾rzte und Apotheker bei der Entstehung von Benzodiazepinabhängigkeit zusätzlich zu den Konsumenten selbst eine Schlüsselposition einnehmen [6,17], bemüht sich die Gesetzgebung in vielen Ländern, das Verschreibungsverhalten von ¾rzten und die Abgabevorschriften in Apotheken für diese Substanzen restriktiv zu gestalten, teilweise mit Erfolg, was die Senkung des Konsums anbelangt [18,19]. Die Verschreibungszahlen sind in vielen Ländern in den 90er-Jahren kontinuierlich gesunken (Beispiele: Ontario vgl.…”