Real-time prescription data appear to have helped Canadian pharmacists stop “doctor shoppers” from getting excessive amounts of opioid painkillers and tranquilizers, according to a new study.

After British Columbia introduced a province-wide prescription database in 1995, there was a sudden drop in the number of inappropriate prescriptions of the two types of drugs, researchers found.

“I am excited to see this,” said Dr. Andrew Kolodny, a psychiatrist in New York and president of Physicians for Responsible Opioid Prescribing.

“There are now millions of Americans who have this disease of opioid addiction, and once addicted you are going to do everything possible to get your opioids,” added Kolodny, who was not involved in the new research.

The Canadian findings come less than a week after New York’s Governor Andrew Cuomo signed a law requiring the state to create a real-time prescription drug database called I-STOP.

Opioids such as OxyContin and Vicodin are powerful painkillers and are commonly used in cancer patients or for a few days after surgeries. But they are also highly addictive and can trigger serious side effects, such as heart problems and breathing failure.

Nearly 15,000 Americans died from an overdose of the medications in 2008 alone, eclipsing the death toll from cocaine and heroin combined.

One way to obtain the coveted drugs is to “shop” between doctors, getting separate prescriptions and filling them at different pharmacies to avoid suspicion. Sometimes the medicines are for personal use and sometimes they are resold illegally.

British Columbia was the first province in Canada to implement a real-time database that enables pharmacists to see a patient’s recent prescriptions, according to Colin Dormuth, an epidemiologist at the University of British Columbia in Vancouver.

If pharmacists suspect foul play - say, when a customer tries to get two or more opioid prescriptions filled at different pharmacies within one week - they can sound the alarm or deny dispensing the drugs.

“There was an immediate drop in these inappropriate prescriptions,” said Dormuth, who led the new research, which was published in the CMAJ, the journal of the Canadian Medical Association.

Inappropriate opioid prescriptions to people on social assistance fell from 3.2 percent to 2.1 percent after the new system, called PharmaNet, was introduced. And suspect prescriptions of benzodiazepines - a class of tranquilizers that exacerbate the side effects of opioids - dipped from 1.2 percent to 0.71 percent.

Dormuth said the number of inappropriate prescriptions is likely much higher than the new estimates, because the study’s definition of “inappropriate” was narrow.

“The cost of implementing these networks in terms of the hardware and resources to build them is probably trivial compared to the millions of inappropriate prescriptions that can be prevented,” he told Reuters Health.

Prescription drug monitoring programs already exist across the U.S., but very few of them are real-time and there is little evidence that they work.

Kolodny said the new study helps provide that evidence and support the use of widespread programs like PharmaNet and I-STOP.

SOURCE: CMAJ, online September 4, 2012.

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