Legislation significantly decreased potentially inappropriate drug prescriptions

New legislation and a centralized prescription monitoring system dramatically reduced prescription rates for frequently misused drugs in Ontario, according to new research conducted at the Institute for Clinical Evaluative Sciences (ICES) and St. Michael’s Hospital.

Thousands of Canadians die every year of drug overdoses from misused prescription drugs, including opioids, benzodiazepines and stimulants. Canada has one of the highest opioid consumptions per capita in the world, leading to increasing concern among Ontario physicians and public health officials.

In November 2011, Ontario passed the Narcotics Safety and Awareness Act. The act increased prescriber accountability by requiring physicians to identify themselves by name and their College registration number on prescriptions for all narcotics and other controlled substances dispensed in Ontario. This legislation also mandated the development of the Narcotics Monitoring System, which was launched in May 2012. The monitoring system records prescriber, pharmacist and patient information for all dispensed narcotics and other controlled drugs, and provides extra information to pharmacists regarding potentially inappropriate drug-seeking behavior when dispensing prescriptions.  

“Our study shows legislation can have a powerful impact on reducing harmful prescribing patterns. However, it’s important to recognize that these recent policies, haven’t solved the problem,” said lead author Tara Gomes, a scientist at ICES and the Li Ka Shing Knowledge Institute of St. Michael’s Hospital.

“In 2013, we still found that approximately one of every hundred prescriptions for opioids was potentially inappropriate.” Researchers deemed a prescription potentially inappropriate if it was refilled early (dispensed within seven days of an earlier prescription for at least 30 tablets of a drug in the same class) and originated from a different physician and different pharmacy.

The study, published today in CMAJ Open, looked at prescriptions of benzodiazepines, stimulants and opioids, before and after the Narcotics Safety and Awareness Act was implemented. It found:

• More than 70 million prescriptions for monitored drugs were dispensed during the 6.5- year study period; almost one million of which were deemed highly likely to represent inappropriate prescribing.
• The prevalence of potentially inappropriate benzodiazepine and stimulant prescriptions fell significantly by 58 per cent and 60 per cent, respectively, upon implementation of policy interventions designed to monitor the prescribing of these drugs.
• The prevalence of potentially inappropriate opioid prescriptions also fell 40 per cent following these policy interventions.

“The Narcotics Monitoring System is another tool for healthcare providers to monitor potentially inappropriate prescriptions. However, only pharmacists currently have access to this system. The value of this system could be greatly improved by expanding access to physicians to help them understand patients’ prescribing history and identify potential drug-seeking behavior at the time of writing a prescription,” added Gomes.

The study “Impact of a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs,” was published today in CMAJ Open.

Author block: Gomes T, Juurlink D, Yao Z, Camacho X, Paterson M, Singh S, Dhalla I, Sproule B, Mamdani M.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

For the latest ICES news, follow us on Twitter: @ICESOntario

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

The Ontario Drug Policy Research Network (ODPRN) is an independent, province-wide network of researchers who provide timely, high quality, drug policy relevant research to decision makers in Ontario. For the latest news from the ODPRN, follow us on Twitter: @ODPRN_Research or visit our website at www.odprn.ca

For more information, or to arrange an interview, please contact:

• Deborah Creatura
• ICES
• [email protected]
• (o) 416-480-4780 (c) 647-406-5996

• Geoff Koehler
• Adviser, Media Relations
• St. Michael’s Hospital
• 416-864-6060 ext. 6537
• [email protected]