September 19, 2012

Fighting Prescription Drug Abuse in Real-Time

Victoria, BC—With the federal government launching two new pilot projects to test whether real-time data can reduce inappropriate drug prescribing and abuse, a new Canadian study offers a possible answer to that question.

The recent study in CMAJ (the Canadian Medical Association Journal) found that a centralized prescription network providing real-time information to pharmacists in British Columbia resulted in significant reductions in inappropriate prescriptions for opioid analgesics and benzodiazepines.

According to the study, PharmaNet, a real-time prescription system implemented in British Columbia pharmacies in July 1995 reduced potentially inappropriate prescriptions for opioids and benzodiazepines in two groups of patients—those on social assistance and seniors. Reductions ranged from about one-third (33%) to one-half (49%).

Within 6 months after implementation of PharmaNet in July 1995, the authors said they  documented a relative reduction in inappropriate filled prescriptions for opioids of 32.8% (95% confidence interval [CI] 31.0%–34.7%) among patients receiving social assistance, with inappropriate filled prescriptions for benzodiazepines decreasing by 48.6% (95% CI 43.2%–53.1%).

“Similar and statistically significant reductions were observed among residents 65 years or older,” they added.

“Our study demonstrates that a system like PharmaNet can help reduce the potentially inappropriate prescribing of medications that are prone to misuse," said lead author Colin Dormuth, ScD, of the Therapeutics Initiative at the University of British Columbia. "In the five-year period of our study, the reduction in inappropriate refills was dramatic and sustained after the implementation of PharmaNet."

In the U.S., the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology is conducting pilot projects in Indiana and Ohio to gauge the effects of expanding and improving access to prescription drug monitoring programs as a method to reduce prescription drug abuse.

With the Canadian PharmaNet system, pharmacists have access to the most recent 14 months of a patient's medication use, regardless of which physician prescribed the drugs or which pharmacy dispensed them. The system can be used to identify potentially harmful drug interactions and accidental duplications in therapy as well as potential prescription drug misuse.

The BC study looked at two groups—patients 65 and older and those receiving public assistance, chosen because of the availability of comprehensive data—for a 5-year period from January 1, 1993 to December 31, 1997. Researchers calculated monthly percentages of filled prescriptions for an opioid or a benzodiazepine that were deemed "potentially inappropriate," defined as a second prescription for the same drug issued by a different prescriber and a different pharmacy within 7 days of a previous prescription for at least 30 tablets.

In Canada, most provinces now have a system allowing pharmacists to view a patient's up-to-date medication history at the time of dispensing a medication or a real-time monitoring program specifically aimed at monitoring prescription drugs prone to misuse. The second approach was adopted earlier this year by Ontario.

U.S. Pharmacist Social Connect