Painkiller, sedative prescribing fell with central drug net

Inappropriate prescriptions for drugs prone to misuse and addiction, such as opioid painkillers, decreased when British Columbia linked its pharmacies and hospitals with a real-time monitoring system, researchers have found.

In Tuesday's issue of the Canadian Medical Association Journal, investigators in B.C. and Ontario reviewed prescription records for three types of drugs between 1993 and 1997:

• Benzodiazepines including sedatives and anti-anxiety drugs such as diazepam and lorazepam.
• Opioid analgesics such as morphine, codeine, oxycodone.
• Non-steroidal anti-inflammatory drugs or NSAIDs as a control.

"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 by our definition," lead author Colin Dormuth of the Therapeutics  Initiative at the University of British Columbia and his co-authors concluded.

"These findings provide empirical evidence that centralized prescriptions networks can reduce inappropriate prescribing and dispensing of prescriptions by offering health care professionals real-time access to prescription data."

In the study, potentially inappropriate prescriptions were defined as a second prescription for the same drug  issued by a different doctor and a different pharmacy within seven  days of a previous prescription for at least 30 tablets.

In the 30 months before PharmaNet was implemented, 3.2 per cent of opioid and 1.2 per cent of benzodiazepine filled prescriptions on average were deemed inappropriate, the researchers said.

But the number of inappropriate prescriptions was less than one per cent.

The researchers estimated inappropriate prescriptions fell 0.28 per cent for opioids and 0.05 per cent for benzodiazepines per month.

As expected, inappropriate prescriptions for NSAIDs were infrequent for both groups that the researchers looked at: people aged 65 years and over and patients receiving social assistance.

One of the drawbacks of the study is that the analysis was based on data from 17 years ago.

The study was funded by a grant from the Canadian Institutes of Health Research (CIHR) and the B.C. Ministry of Health to the University of British Columbia. One of the authors received consultancy fees from several pharmaceutical firms.