title: The total sale of prescription drugs with an abuse potential predicts the number of excessive users: a national prescription database study.
abstract: BACKGROUND
  Prescription drug sales may vary considerably across regions and over time. This study aimed to assess whether there is an association between mean drug sales and prevalence of excessive use in a range of psychotropic prescription drugs with an abuse potential, and if so, whether the variation in mean drug sales mostly reflects variation in the prevalence of excessive use or mostly reflects variation in non-excessive use.
  
  
  METHODS
  Data on all filled prescriptions taken from the Norwegian prescription database for 10 drugs with an abuse potential (pain relievers, anxiolytics, and hypnotics) during one calendar year (2005) in Norway (n = 4,053,624) included number of defined daily doses (DDD). These were aggregated to individual level (n = 815,836) and county level (n = 19).
  
  
  RESULTS
  Analyses of individual level data showed that the distribution of drug use was skewed; those who used more than 365 DDD per year accounted for almost half of the sales of both anxiolytics and hypnotics. At the county level, the mean sales per inhabitant and the prevalence of excessive users were closely correlated, but both prevalence of non-excessive use and prevalence of excessive drug use were associated with the county-wise variation in mean drug sales.
  
  
  CONCLUSIONS
  Despite a strong individual control of access to psychotropic drugs through health personnel' prescribing, a small proportion of users account for a large fraction of the sales of these drugs. The sales vary significantly between regions and this variation is closely associated with the prevalence of excessive users. This suggests that sales figures as such may be used as an indicator to monitor variations in excessive use between regions and over time, and to evaluate interventions targeting over-prescription and excessive use.
authors.affiliation: Norwegian Institute for Alcohol and Drug Research (SIRUS), Øvre Slotts g 2b, P.O. Box 565, Sentrum, 0105, Oslo, Norway. ir@sirus.no.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Rossow
authors.affiliation: Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway. j.g.bramness@medisin.uio.no.|Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway. j.g.bramness@medisin.uio.no.
authors.forename: Jørgen G
authors.initials: JG
authors.lastname: Bramness
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D009664:Norway; D011619:Psychotropic Drugs / Q000008:administration & dosage*; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs