A prescription drug monitoring program in Canada dramatically reduced the number of inappropriate prescriptions for opioid painkillers and anti-anxiety drugs, according to a new study in the Canadian Medical Association Journal.
The study found that PharmaNet, a prescription monitoring system used by pharmacies in British Columbia, reduced inappropriate prescriptions of opioids by over one third among patients on public assistance. Inappropriate prescriptions of benzodiazepines fell by nearly one half in the same group of patients. Similar reductions were noted in patients 65 years and older.
“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 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.”
The PharmaNet system, begun in British Columbia in 1995, allows pharmacists to view the past 14 months of a patient’s prescriptions, regardless of which doctor wrote the prescription or which pharmacy filled them. The database enables pharmacists to identify potentially harmful drug interactions, as well as potential misuse, such as doctor shopping or drug diversion.
An “inappropriate prescription” was defined as a second prescription for the same drug issued by a different doctor and a different pharmacy within 7 days of a previous prescription.
Benzodiazepines and opioid painkillers are prescription drugs that are prone to misuse and addiction. Benzodiazepines include sedatives and anti-anxiety drugs such as diazepam and lorazepam. Opioids are taken for pain relief and include morphine, codeine, oxycodone and other drugs.
Most Canadian provinces have adopted similar systems allowing pharmacists to view a patient’s medication history at the time of dispensing or a real-time monitoring program aimed at monitoring drugs prone to misuse.
In the United States, 42 states have prescription monitoring programs and six states have plans to develop them. The Food and Drug Administration and the Centers for Disease Control and Prevention have called for broadening such efforts. Many doctors, however, feel the programs are not “user friendly” and cumbersome.
The PharmaNet study covered a five year period from 1993 to 1997. Because data was available for seniors and patients on public assistance, the study focused on those two groups of patients.
“Our analysis showed that the implementation of a province-wide centralized prescription network was associated with large, immediate and sustained reductions in filled prescriptions for opioid analgesics and benzodiazepines deemed inappropriate,” the authors wrote. “These findings provide empirical evidence that centralized prescription networks can reduce inappropriate prescribing and dispensing of prescriptions by offering health care professionals real-time access to prescription data.”
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