PreScription: IJPC is now all Digital Allen, Jr, Loyd V
International journal of pharmaceutical compounding,
2024 Jan-Feb, Letnik:
28, Številka:
1
Journal Article
The use of prescription opioid medications has increased greatly in the United States during the past two decades; in 2010, there were 16,651 opioid-related deaths. In response, hundreds of federal, ...state, and local interventions have been implemented. We describe trends in the diversion and abuse of prescription opioid analgesics using data through 2013.
We used five programs from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System to describe trends between 2002 and 2013 in the diversion and abuse of all products and formulations of six prescription opioid analgesics: oxycodone, hydrocodone, hydromorphone, fentanyl, morphine, and tramadol. The programs gather data from drug-diversion investigators, poison centers, substance-abuse treatment centers, and college students.
Prescriptions for opioid analgesics increased substantially from 2002 through 2010 in the United States but then decreased slightly from 2011 through 2013. In general, RADARS System programs reported large increases in the rates of opioid diversion and abuse from 2002 to 2010, but then the rates flattened or decreased from 2011 through 2013. The rate of opioid-related deaths rose and fell in a similar pattern. Reported nonmedical use did not change significantly among college students.
Postmarketing surveillance indicates that the diversion and abuse of prescription opioid medications increased between 2002 and 2010 and plateaued or decreased between 2011 and 2013. These findings suggest that the United States may be making progress in controlling the abuse of opioid analgesics. (Funded by the Denver Health and Hospital Authority.).
BackgroundIn 2015, Octaplex and Clottafact were identified among the most prescribed medications with a high financial impact in the university hospital. Expenses for those drugs increased ...respectively by 10% (+€23 900) and 14% (+€239 300) in 2015.PurposeThe aim of the study was to evaluate the appropriateness of Octaplex and Clottafact prescriptions to see if this increase was justified.Material and methodsWe audited the prescriptions made in the first quarter of 2016 with a set of criteria based on these medications’ indications. Those criteria were divided in 3 groups: conformity of the prescription with regulatory demands (group 1), for example (IE) was there a computerised traceability of the medication’s prescription? Relevance of the prescription regarding patient biological (group 2) and clinical (group 3) data.We assigned a score for each criterion, weighted to reflect its importance. The sum of scores then gave each prescription a letter, characterising their appropriateness. The letters were: A=appropriate, B=intermediately appropriate and C=inappropriate. This method was approved by physicians and pharmacists, and members of the commission for medicines of the hospital.Results16% (44/272) of prescriptions were audited: 28% (14/111) were for Octaplex and 19% (30/161) for Clottafact. Group 1: 50% of prescriptions were classified as A (22/44), 36% (16/44) were B and 14% (6/44) were C. only 34% (15/44) were computerised. Group 2: 54% were classified as A (24/44), 41% (18/44) were B and 5% (2/44) were C. For 37% (11/30) of fibrinogen prescriptions, there was no hypofibrinogenaemia.Group 3: 75% (33/44) were classified as A, 20% (9/44) were B and 5% (2/44) were C (for those 2 prescriptions, there was no mention of bleeding or blood transfusion in the patients’ records).Conclusion25% (11/44) of the prescriptions were appropriate, 72% (32/44) were intermediately appropriate and 3% (1/44) seemed inappropriate. This is acceptable considering that these medications are usually administered in emergencies, when staff have to think and act fast. These results have been presented to the prescribers with a reminder of those medicines with indications of a ‘last resort’ character. This type of audit will be renewed periodically, the set of criteria being adaptable to any medication.No conflict of interest
Most US studies of national trends in medical and nonmedical use of prescription opioids have focused on adults. Given the limited understanding in these trends among adolescents, we examine national ...trends in the medical and nonmedical use of prescription opioids among high school seniors between 1976 and 2015.
The data used for the study come from the Monitoring the Future study of adolescents. Forty cohorts of nationally representative samples of high school seniors (modal age 18) were used to examine self-reported medical and nonmedical use of prescription opioids.
Lifetime prevalence of medical use of prescription opioids peaked in both 1989 and 2002 and remained stable until a recent decline from 2013 through 2015. Lifetime nonmedical use of prescription opioids was less prevalent and highly correlated with medical use of prescription opioids over this 40-year period. Adolescents who reported both medical and nonmedical use of prescription opioids were more likely to indicate medical use of prescription opioids before initiating nonmedical use.
Prescription opioid exposure is common among US adolescents. Long-term trends indicate that one-fourth of high school seniors self-reported medical or nonmedical use of prescription opioids. Medical and nonmedical use of prescription opioids has declined recently and remained highly correlated over the past 4 decades. Sociodemographic differences and risky patterns involving medical and nonmedical use of prescription opioids should be taken into consideration in clinical practice to improve opioid analgesic prescribing and reduce adverse consequences associated with prescription opioid use among adolescents.
In response to the opioid epidemic, many states implemented mandates requiring providers to check prescription drug monitoring programs (PDMPs) before prescribing opioids. We examine how overlapping ...benzodiazepine and opioid prescriptions changed after Kentucky implemented a PDMP mandate in July 2012.
We conducted an interrupted time series analysis using monthly data from Kentucky’s PDMP from 2010 to 2016. Separate analyses were conducted for overlapping prescriptions from a single provider or multiple providers, and by sex and age group. We also conducted an individual-level longitudinal analysis that compared changes in utilization patterns after the mandate went into effect to changes in earlier periods during which the mandate was not in effect.
Kentucky’s PDMP mandate was associated with an immediate 7.5 % decline in the rate of overlapping benzodiazepine and opioid prescriptions and a significant change in the trend from increasing to decreasing. Approximately half of the immediate effect in level terms was explained by decreases in overlapping prescriptions written by a single provider. Our longitudinal analysis suggests that over one year the mandate reduced initiation of overlapping prescriptions by 29.3 % and reduced continuation of overlapping prescriptions by 9.4 %. The effects of the policy were largest for women and men aged 36–50.
Though not the main rationale for the policy, Kentucky’s PDMP mandate reduced overlapping prescriptions of benzodiazepines and opioids. Further efforts to reduce overlapping prescriptions should consider the effects on populations such as women over 50, who have high rates of overlapping prescriptions.
•In response to the opioid epidemic, states implemented prescription drug monitoring program mandates.•The mandates require providers to check PDMPs before prescribing opioids.•Our analyses examine effects of Kentucky’s PDMP mandate on concurrent benzodiazepine use among opioid users.•Though not the main rationale for the policy, Kentucky’s PDMP mandate reduced concurrent benzodiazepine use.•In percentage terms, the effects of the policy were largest for people under 50.
BackgroundSince the beginning of 2014, an increasing number of direct acting antiviral agents (DAAs) have been approved in France for treating chronic hepatitis C virus (HCV). In order to achieve ...high quality treatment with these costly drugs, multidisciplinary treatment planning meetings (RCP) between clinicians and pharmacists take place periodically. The final team decision is a mandatory requisite for DAA prescription which is also subject to strict reimbursement rules. Audits of DAA prescriptions were performed by pharmacists to detect non-conformities before and after an improvement plan (IP) hospital meeting on 1 June 2015.PurposeTo assess the impact of the IP in prescribing DAAs.Material and methodsDAA prescriptions were collected from hospital dispensing software. A data collection audit form was designed containing data about the prescriber and patient, the prescription and RCP decision compliance.Results244 prescriptions were audited (108 for April 2015; 136 for July 2015). In both audits all prescriptions contained at least one error. The main non-conformities detected were: 25% non-authorised prescribers, missing data (13% prescriber identification number, 20% patient’s birth date, 10% international non-proprietary name, 44% length of treatment in weeks rather than in months). The RCP date was reported in only 18% of cases, but only 10% of prescriptions were identified as non-compliant with the RCP decision (9 cases wrong prescribed drug, 2 cases no RCP decision). In the second audit, important improvements were observed for: percentage of authorised prescribers (90%), reported prescriber identification number (54%) and RCP date (35%). 7 prescription deviations from the official RCP decision (5%) were found: type of prescribed drug (3 cases), treatment duration (3 cases) and no RCP decision (1 case). Weak improvements were reported for patient’s birth date (22%) and length of treatment in weeks (49%).ConclusionIn conclusion, the IP meeting was successful, showing that internal audits are effective instruments in identifying weaknesses in the system and in measuring corrective actions. The pharmacist, as an integral member of the multidisciplinary team, has an essential role in guaranteeing the actual application of the RCP decision in order to obtain the best patient outcomes.No conflict of interest.
BackgroundProton pump inhibitors (PPIs) are widely and uncritically used for stress ulcer prophylaxis (SUP) in hospital patients, even though they are not licensed for this indication. Moreover, ...there is growing evidence that PPIs are not as harmless as they were thought to be. Also, there is an increased risk of pneumonia and Clostridium difficile infections, and recently published studies showed a higher incidence of myocardial infarction1 and acute kidney injury2 associated with PPIs.PurposeThe aim of the study was to survey the status quo of the quantity of PPI usage in a university hospital, paying particular attention to plausibility of its use.Material and methodsWe scanned the medication of all patients of seven surgical and internal wards in a point prevalence analysis. With the help of the electronic patient record we also screened prehospital medication lists and discharge letters for PPIs. For each newly initiated and continued PPI prescription, plausibility was checked, guided by approved indications and published risk factors3 4 for gastrointestinal bleeding.ResultsThe medication of 192 patients was scanned, of whom 66% received a PPI. Of these 56% had a prehospital prescription and this was continued in 89%. At discharge, overall 85% had a PPI listed, with 41% of patients being newly initiated on the treatment. For all patients scanned, we identified 40% of PPI prescriptions being unplausible, and 36% were new inpatient prescriptions. In total, 8% of all patients were leaving hospital with a new unplausible PPI prescription.ConclusionWe found that one-third of PPI prescriptions were not reasonable in our patients. The uncritical prescription of PPIs in hospital may lead to a vicious circle of inpatient prescription, which is continued in outpatient care, without questioning the indication, and further continuation in the case of another hospitalisation. With respect to the growing evidence of the hazard potential of PPIs, it is important to verify the indication for each PPI prescription and reduce unnecessary ‘just in case SUP’.References and/or AcknowledgementsShah, . PLoS ONE 2015Antoniou, et al. CMAJ Open 2015García Rodríguez, et al. Circulation 2011Herzig, et al. J Gen Intern Med 2013No conflict of interest.
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