Harmonizing Post-Market Surveillance of Prescription Drug Misuse: A Systematic Review of Observational Studies Using Routinely Collected Data (2000–2013)

Bianca Blanch, Nicholas A. Buckley, Leigh Mellish, Andrew H. Dawson, Paul S. Haber, Sallie-Anne Pearson
2015 Drug Safety  
Prescription drug misuse is a growing public health concern globally. Routinely collected data provides a valuable tool for quantifying prescription drug misuse. Objective To synthesize the global literature investigating prescription drug misuse utilizing routinely collected, person-level prescription/dispensing data to examine reported measures, documented extent of misuse and associated factors. Methods We searched MEDLINE, Embase, CINAHL, MEDLINE In Process, Scopus citations and Google
more » ... ar for relevant articles published between January 1 2000-July 31 2013. We screened 10,803 abstracts and retrieved 281 full-text manuscripts. Fifty-two peer-reviewed, English-language manuscripts met our inclusion criteria: an aim/method investigating prescription drug misuse and a measure of misuse derived exclusively from prescription/dispensing data. Results Four proxies of prescription drug misuse were used commonly across studies: number of prescribers, dispensing pharmacies, early refills and volume of drugs dispensed. We identified 89 unique measures of misuse across the 52 studies, reflecting the heterogeneity in how measures are constructed; single or composite; different thresholds, cohort definitions and time period of assessment. Consequently, it was not possible to make definitive comparisons about the extent (range reported: 0.01-93.5%), variations and factors associated with prescription drug misuse. Conclusion Routine data collections are relatively consistent across jurisdictions. Despite the heterogeneity of the current literature, our review identifies the capacity to develop universally accepted metrics of misuse applied to a core set of variables in prescription/dispensing claims. Our timely recommendations have the potential to unify the global research field and increase the capacity for routine surveillance of prescription drug misuse. Key points  Prescription drug misuse is increasing globally. This can be monitored readily using routinely collected data; quantifying drug access patterns at the population-level.  Our review identified only four common proxies for prescription drug misuse (number of prescribers; number of dispensing pharmacies; volume of drug(s) dispensed; and/or overlapping prescriptions/early refills) yet they were used to derive 89 unique definitions of misuse due to variations in thresholds, or use alone or in combination.  We recommend the development of consistent and replicable metrics to facilitate monitoring and comparisons of the extent of prescription drug misuse across health care settings and over time. Measures and thresholds of misuse. We identified 89 unique definitions of misuse across 50 studies; only 13 measures were utilized in two or more studies (32 studies in total). There appeared to be an attempt to use pre-existing measure(s) of misuse within, but not between, research groups, however, some groups changed their misuse measures between studies. Sixteen studies reported the number of prescribers and dispensing pharmacies accessed routinely by drug users. As thresholds increased, the proportion of the population exhibiting the behavior decreased (Figures 2a and 2b) . Importantly, the highest proportion of drug users visited 1-2 prescribers or pharmacies when accessing their drug(s). Thirteen of these studies defined a threshold of misuse; 9 studies (69.2%) set the threshold of misuse as ≥3 prescribers or dispensing pharmacies. The thresholds defining misuse impact on the extent of the problem reported across studies. Cohort definition (drug user and misuse cohorts). Misuse was measured more frequently in drug user cohorts (87 instances) than misuse cohorts (33 instances). The extent of misuse was most commonly <10% for drug users (58 instances; 66.7%) and >20% in misuse cohorts (23 instances; 69.7%). However, the extent of misuse ranged considerably between drug user (0.01-63.2%) and misuse cohorts (0.2-93.5%), reflecting the variation in the measures and thresholds utilized, and the cohort definition. A strict cohort definition increased the reported extent of misuse; misuse cohorts had stricter cohort definitions than drug user cohorts. In general, for drug user cohorts, a high reported extent of misuse reflected a low threshold for misuse and for misuse cohorts, the higher the reported extent of misuse, the stricter the cohort definition. 3.4.3 Time period of assessment. Measures of misuse were assessed from 7 days to 4 years. The most commonly investigated time period was 12 months, utilized in 44% of instances of reporting misuse. Due to the heterogeneity of of the Maine prescription monitoring program from 2006 to 2010. J Subst Use. 2013;18(6):467-75. 22. Hernandez SH, Nelson LS. Prescription drug abuse: Insight into the epidemic. Clin Pharmacol Ther. 2010;88(3):307-17. 23. Secora AM, Dormitzer CM, Staffa JA, Dal Pan GJ. Measures to quantify the abuse of prescription opioids: A review of data sources and metrics.
doi:10.1007/s40264-015-0294-8 pmid:25968812 fatcat:ltwgrrxlajgs7ewmbbttwujrpq