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


Background — The researchers assessed the impact of new legislation and a centralized prescription monitoring system (implemented November 2011 and May 2012, respectively), on the dispensing of prescriptions suggestive of misuse.

Methods — The researchers conducted a time series analysis of publically-funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly from January 2007 to May 2013. In the primary analysis, a prescription was deemed potentially inappropriate if it was dispensed within 7 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.

Results — The prevalence of potentially inappropriate opioid prescriptions decreased by 13.2% after enactment of the new legislation (from 1.59% in October 2011 to 1.38% in April 2012; p=0.01). No further significant change in trend was observed after the introduction of the narcotic monitoring system (NMS) (p=0.78). By May 2013, the prevalence had dropped to 0.95%. Inappropriate benzodiazepine prescribing was significantly influenced by both the legislation (p<0.001) and the NMS (p=0.05), which together reduced potentially inappropriate prescribing by 57.5% between October 2011 and the end of the study period (from 0.40% to 0.17%). The prevalence of potentially inappropriate prescribing of stimulants was significantly influenced by the introduction of the NMS, falling from 0.68% in April 2012 to 0.27% in May 2013, following introduction of the NMS (p=0.02).

Interpretation — For a select group of drugs prone to misuse and diversion, legislation and implementation of a prescription monitoring program dramatically reduced the prevalence of prescriptions highly suggestive of misuse.



Gomes T, Juurlink D, Yao Z, Camacho X, Paterson M, Singh S, Dhalla I, Sproule B, Mamdani M. CMAJ Open. 2014; 2(4):E256-61. Epub 2014 Oct 1.

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