title: Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis.
abstract: BACKGROUND
  The increased use of opioid analgesics, sedative hypnotics and stimulants, coupled with the associated risks of overdose have raised concerns around the inappropriate prescribing of these monitored drugs. We assessed the impact of new legislation, the Narcotics Safety and Awareness Act, and a centralized Narcotics Monitoring System (implemented November 2011 and May 2012, respectively), on the dispensing of prescriptions suggestive of misuse.
  
  
  METHODS
  We conducted a time series analysis of publicly funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly in Ontario from January 2007 to May 2013, based on information in the Ontario Public Drug Benefit Database. In the primary analysis, a prescription was deemed potentially inappropriate if it was dispensed within 7 days of an earlier prescription and was for at least 30 tablets of a drug in the same class as the earlier prescription, but originated from a different physician and a different pharmacy.
  
  
  RESULTS
  After enactment of the new legislation, the prevalence of potentially inappropriate opioid prescriptions decreased by 12.5% in 6 months (from 1.6% in October 2011 to 1.4% in April 2012; p = 0.01). No further significant change was observed after the introduction of the narcotic monitoring system (p = 0.8). By May 2013, the prevalence had dropped to 1.0%. Inappropriate benzodiazepine prescribing was significantly influenced by both the legislation (p < 0.001) and the monitoring system (p = 0.05), which together reduced potentially inappropriate prescribing by 50.0% between October 2011 and May 2013 (from 0.4% to 0.2%). The prevalence of potentially inappropriate prescribing of stimulants was significantly influenced by the introduction of the monitoring system in May 2012, falling from 0.7% in April 2012 to 0.3% in May 2013 (p = 0.02).
  
  
  CONCLUSIONS
  For a select group of drugs prone to misuse and diversion, legislation and a prescription monitoring program reduced the prevalence of prescriptions suggestive of misuse. This suggests that regulatory interventions can promote appropriate prescribing which could potentially be applied to other jurisdictions and drugs of concern.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ont. ; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Sunnybrook Research Institute, Toronto, Ont. ; Department of Medicine, University of Toronto, Toronto, Ont.
authors.forename: David
authors.initials: D
authors.lastname: Juurlink
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Yao
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Ximena
authors.initials: X
authors.lastname: Camacho
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ont. ; Department of Family Medicine, McMaster University, Hamilton, Ont.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors.forename: Samantha
authors.initials: S
authors.lastname: Singh
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Department of Medicine, St. Michael's Hospital, Toronto, Ont. ; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
authors.forename: Irfan
authors.initials: I
authors.lastname: Dhalla
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont. ; Department of Psychiatry, University of Toronto, Toronto, Ont. ; Centre for Addiction and Mental Health, Toronto, Ont.
authors.forename: Beth
authors.initials: B
authors.lastname: Sproule
authors.affiliation: Department of Medicine, St. Michael's Hospital, Toronto, Ont. ; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ont. ; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani