title: Access and intensity of use of prescription analgesics among older Manitobans.
abstract: BACKGROUND
  Under-treatment of pain is frequently reported, especially among seniors, with chronic non-cancer pain most likely to be under-treated. Legislation regarding the prescribing/dispensing of opioid analgesics (including multiple prescription programs [MPP]) may impede access to needed analgesics.
  
  
  OBJECTIVE
  To describe access and intensity of use of analgesics among older Manitobans by health region.
  
  
  METHODS
  A cross-sectional study of non-Aboriginal non-institutionalized Manitoba residents over 65 years of age during April 1, 2002 to March 31, 2003 was conducted using the Pharmaceutical Claims data and the Cancer Registry from the province of Manitoba. Access to analgesics (users/1000/Yr) and intensity of use (using defined daily dose [DDD] methodology) were calculated for non-opioid analgesics, opioids, and multiple-prescription-program opioids [MPP-opioids]. Usage was categorized by age, gender, and stratified by cancer diagnosis. Age-sex standardized rates of prevalence and intensity are reported for the eleven health regions of Manitoba.
  
  
  RESULTS
  Thirty-four percent of older Manitobans accessed analgesics during the study period. Female gender, increasing age, and a cancer diagnosis were associated with greater access and intensity of use of all classes of analgesics. Age-sex standardized access and intensity measures revealed the highest overall analgesic use in the most rural / remote regions of the province. However, these same regions had the lowest use of opioids, and MPP-opioids among residents lacking a cancer diagnosis.
  
  
  CONCLUSIONS
  This population-based study of analgesic use suggests that there may be variations in use of opioids and other analgesics depending on an urban or rural residence. The impact of programs such as the MPP program requires further study to describe its impact on analgesic use.
authors.affiliation: Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada. csadowski@pharmacy.ualberta.ca
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Sadowski
authors.forename: Anita G
authors.initials: AG
authors.lastname: Carrie
authors.forename: Ruby E
authors.initials: RE
authors.lastname: Grymonpre
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Metge
authors.forename: Phillip
authors.initials: P
authors.lastname: St John
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs; D012111:Residence Characteristics; D012424:Rural Population; D012737:Sex Factors; D014505:Urban Population
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D055553:Prescription Drugs