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Substance Abuse : Research and Treatment 2022To describe naloxone dispensing in Medicaid fee-for-service (FFS) and examine relationships between copays and coverage limits for naloxone and its dispensing rates.
AIMS
To describe naloxone dispensing in Medicaid fee-for-service (FFS) and examine relationships between copays and coverage limits for naloxone and its dispensing rates.
METHODS
Cross-sectional study using Medicaid FFS State Drug Utilization Data to quantify the use of naloxone in 2018. The primary outcomes of this study were the proportion of naloxone prescriptions relative to all prescriptions and all opioid prescriptions dispensed in each state. We obtained drug benefit design information from the Medicaid Behavioral Health Services Database. The primary analysis examined the influence of copays (yes/no), copay amounts, and coverage limits on medication dispensing using simple linear regression, excluding states with no measurable use or less than 5% Medicaid FFS.
RESULTS
We found substantial variability across 50 states and DC in the proportion of prescriptions dispensed for Narcan and generic naloxone. We found a positive relationship between copay and copay amount and dispensing of generic naloxone. However, a sensitivity analysis including the broadest possible cohort of states failed to confirm this relationship. We found no other relationships between copays or coverage limits and dispensing of any naloxone formulation.
CONCLUSIONS
Substantial variation exists between the rates of naloxone dispensing across the US for Medicaid patients, but we did not find a meaningful relationship between plan design and dispensing. Whether drug benefit designs in Medicaid influence naloxone use requires further evaluation to avoid limiting access to this life-saving medication.
PubMed: 36199698
DOI: 10.1177/11782218221126972 -
Scandinavian Journal of Pain Apr 2019Background and aims While the Nordic countries have considerably stricter controls on opioid prescribing for chronic non-cancer pain than other countries, previous...
Background and aims While the Nordic countries have considerably stricter controls on opioid prescribing for chronic non-cancer pain than other countries, previous research has warned that prescription of strong opioids is increasing. This study examines consumption of and developments in dispensed prescribed opioids to individuals receiving ambulatory care from 2006 to 2017, using publicly available data from each of three Nordic countries' national prescription registries. Methods Repeated, cross-sectional design. One-year prevalence of all dispensed prescribed opioids in ATC N02A group were reported for Norway, Denmark, and Sweden in the period 2006-2017 by gender. One-year prevalence of the weak opioids tramadol and codeine and the strong opioid oxycodone were then reported separately over this period for each country. The mean defined daily dose (DDD) per user per year, an estimate of the amount of opioids prescribed, was reported for each of the three opioids in 2016. Results Patterns of dispensed prescribed opioids differ greatly between 2006 and 2017 and between countries, with tramadol increasing in Norway, codeine declining across the board, and oxycodone increasing in all three countries. Norway exceeded Sweden and Denmark in prevalence of all dispensed prescribed opioids, with 12.1% of the female Norwegian population and 9.2% of the male Norwegian population dispensed at least one prescribed opioid as an outpatient in 2016. Norway's high overall prevalence rates are tempered by dispensing the lowest mean doses of both weak opioids compared to Sweden. Similarly, Sweden dispenses the lowest mean doses of oxycodone but to the largest proportion of its population (3.0%). Conclusions Significant shifts have occurred in the dispensing of prescribed opioids in Norway, Sweden, and Denmark over the past 12 years. The increasing prevalence of oxycodone in all three countries should continue to be monitored. Prescription registries provide a wealth of publicly available data that can be used to monitor and to guide prescribing policies in a more knowledge-based direction.
Topics: Aged; Analgesics, Opioid; Denmark; Drug Prescriptions; Female; Humans; Male; Norway; Oxycodone; Practice Patterns, Physicians'; Registries; Sweden; Tramadol
PubMed: 30677000
DOI: 10.1515/sjpain-2018-0307 -
Basic & Clinical Pharmacology &... Sep 2017Phthalates are known endocrine disruptors. Not commonly recognized, phthalates are used as excipients in a number of drug formulations. We aimed to describe the sale of... (Comparative Study)
Comparative Study
Phthalates are known endocrine disruptors. Not commonly recognized, phthalates are used as excipients in a number of drug formulations. We aimed to describe the sale of phthalate-containing drugs in Denmark from 2004 to 2015. National data on annual sale of medications (tablets only) were accessed from medstat.dk. Data from the Danish Medicines Agency on phthalate content per tablet were merged with data on total sale for each active substance and drug formulation. We used the 'defined daily dose' (DDD) as the unit of sale and calculated the total amount of phthalate (mg) dispensed per 1000 inhabitants. Specific tablet content was compared with the maximum daily exposure limits defined by regulatory agencies for diethyl phthalate (DEP) and dibutyl phthalate (DBP) of 4.0 and 0.01 mg/kg/day, respectively. Use of phthalate-containing drugs in Denmark was common. We found 154 drug products containing five different phthalates. Two low-molecular-weight phthalates and three high-molecular-weight phthalates were identified, with a total sale of 59.4 and 112 DDD per 1000 inhabitants per day during the study period, respectively. The highest amount of DBP was found in multi-enzymes (24.6-32.8 mg per DDD) and mesalazine (12.5-26.4 mg per DDD). Budesonide, lithium and bisacodyl also exceeded the DBP exposure limit of 0.01 mg/kg/day. Other drugs had high levels of DEP, although not exceeding the exposure limit. Sales of phthalate-containing drugs in Denmark from 2004 to 2015 were substantial, and phthalate exposure from several products exceeded the regulatory exposure limit introduced in 2014.
Topics: Adult; Databases, Factual; Denmark; Dibutyl Phthalate; Drug Contamination; Endocrine Disruptors; Environmental Exposure; Excipients; Humans; Legislation, Drug; Molecular Weight; Pharmaceutical Preparations; Phthalic Acids; Plasticizers; Tablets
PubMed: 28371296
DOI: 10.1111/bcpt.12781 -
BioMed Research International 2017To describe dental prescriptions for anxiolytics, sedatives, and hypnotics for Brazilian outpatients in 2010. (Clinical Trial)
Clinical Trial
OBJECTIVE
To describe dental prescriptions for anxiolytics, sedatives, and hypnotics for Brazilian outpatients in 2010.
METHODS
A cross-sectional study was conducted using data on the use of anxiolytics, sedatives, and hypnotics from the Brazilian Health Surveillance Agency, Brazil, 2010. For each prescription, prescribed drugs and the prescribed amount were identified. Prescribed medications were classified according to Anatomical Therapeutic Chemical code. We calculated the number of Defined Daily Doses (DDD) for anxiolytics, sedatives, and hypnotics by code, their mean DDD, and DDD per inhabitant per year.
RESULTS
There were 16,436 prescriptions dispensed, including anxiolytics, sedatives, and hypnotics. These prescriptions corresponded to 3,555,780.50 mg, distributed as 2,286,200.50 mg (64.30%) of anxiolytics and 1,269,580.00 mg (35.70%) of sedatives and hypnotics. This amount allowed treating approximately 474,106 individuals (number of DDD). The anxiolytics most frequently dispensed were bromazepam (25.30%), alprazolam (19.19%), and diazepam (15.60%). Sedatives and hypnotics mostly prescribed were zolpidem (9.55%), midazolam (6.99%), and flunitrazepam (2.14%). The per capita rates (100,000 inhabitants) of anxiolytics and sedatives/hypnotics were 6.83 and 1.78, respectively.
CONCLUSIONS
Benzodiazepines and derivatives were the most frequently prescribed drugs. There was a low rate of dental prescriptions for anxiolytics, sedatives, and hypnotics, although excessive doses were concentrated in the same prescription.
Topics: Anti-Anxiety Agents; Benzodiazepines; Brazil; Cross-Sectional Studies; Dentists; Drug Prescriptions; Female; Humans; Hypnotics and Sedatives; Male
PubMed: 28638826
DOI: 10.1155/2017/2841549 -
Journal of Pharmacy & Bioallied Sciences Jul 2022Dental caries is considered to be the most common pathology of the oral cavity. The pathogenesis of dental carries is believed to be because of imbalance in the... (Review)
Review
Dental caries is considered to be the most common pathology of the oral cavity. The pathogenesis of dental carries is believed to be because of imbalance in the microbiological niche creating an ecological pressure. Probiotics are living microorganisms which when dispensed in appropriate amounts can benefit the health of the host. They have posed as a promising replacement to antibiotics that can aid in solving dental issues like dental caries. There are numerous Randomized control trials to validate this fact. There are also various modes through which a probiotic can be delivered against dental caries. Numerous new avenues like effector strains and synbiotics are also explored nowadays. The present review is about the significance of probiotics in the management of dental caries.
PubMed: 36110745
DOI: 10.4103/jpbs.jpbs_801_21 -
Journal of Education and Health... 2021Medication errors (MEs) are a critical worldwide concern and can cause genuine clinical ramifications for patients. Studies concerning such errors have not been... (Review)
Review
Medication errors (MEs) are a critical worldwide concern and can cause genuine clinical ramifications for patients. Studies concerning such errors have not been undertaken as much in the Middle Eastern region. The aim of this study was to systematically review and identify studies done in the Middle Eastern nations to recognize the principle contributory factors included and to estimate the prevalence in the region. A review of the retrospective, prospective, cohort, and case-control studies based on MEs in the Middle Eastern nations was directed in January 2020 utilizing the accompanying databases: Embase, Medline, PubMed, Ebsco, Cochrane, Scopus, and Prospero. The search methodology incorporated all ages and in English only dating back to 2010. The search methodology included articles about MEs in the Middle East with errors in people of all ages, articles in English, and articles dating back to 2010. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses appraisal instrument was used to assess the quality of the included articles. Individual data extraction, pooled analysis, and the accompanying databases were used for data analysis of the MEs in eligible studies. Fifteen of the 18 articles reviewed from four Middle Eastern countries had low risk of bias, while three out of 18 had medium risk of bias. A total of 58,221 reported people were studied, with a total of 34,730.9 reported MEs. The pooled analysis showed that numbers of errors were mainly prescribing errors ( = 22,715.25), general prescription errors ( = 8097.16), and commission errors ( = 158.2). Iran had the highest rate amid the reported administration errors, at 25.07% (599.11/2388.9). Measuring a patient's clinical laboratory values was another less common type of prescription ME. Lebanon reported to have the highest monitoring errors, with a rate of 13.13% (277.91/2117). A negative trend was shown in the amount of MEs in the vast majority of the nations under the examination. The under-reporting or uncertain information recommended that significan changes are needed in the healthcare sector. There is solid need of literature on healthcare services in the region to completely understand and address the MEs and issues.
PubMed: 34395664
DOI: 10.4103/jehp.jehp_1549_20 -
Molecular Genetics and Metabolism... Dec 2019Foods for Special Medical purposes (Phe-free protein substitutes [PS] and low protein foods [LPFs]) are central to successful dietary management of patients with...
BACKGROUND
Foods for Special Medical purposes (Phe-free protein substitutes [PS] and low protein foods [LPFs]) are central to successful dietary management of patients with phenylketonuria (PKU). In the UK, PS and LPFs are prescribed by primary care general practitioners (GPs) and dispensed by high street pharmacists or via home delivery companies. As patients and carers commonly reported access issues with PS and LPFs through the National Society for PKU (NSPKU) helpline, the NSPKU collected more information about the extent of prescriptions issues via a questionnaire.
METHODS
A cross sectional online survey was carried out consisting of 7 multiple choice and 3 open questions. The questionnaire was available via the NSPKU website over a 9-month period (15th May 2018-31st January 2019). Carers or patients with PKU were invited to participate if they had any problems accessing PS and LPF.
RESULTS
There were 252 responses. 65% for children and 35% for adults, aged ≥18y with PKU. 59% ( = 146/246) of responses described difficulties accessing basic LPF (bread, pasta) and 33% ( = 81/248) PS. 36% ( = 88/248) said problems had re-occurred >1y, and 40% ( = 99/248) for <3 months. 59% ( = 146/246) had supply issues with LPF and 33% ( = 81/246) with PS. 18% ( = 42/234) reported that the local NHS authority had refused, restricted or had a policy to block treatment access; 27% ( = 63/234) cited GPs declining requests or restricting prescription amounts. 21% ( = 49/234) could not access all their products via a pharmacy, 40% ( = 93/234) said their home delivery system failed, and 15% ( = 34/234) of the dispensed prescribed products were out of date, incorrect, damaged or poor quality. For patients and carers these issues caused: stress (87%, = 210/241); they considered PKU was not taken seriously by professionals (66%, = 160/241); they reduced patient access to LPF and PS (53%, = 128/241); and affected the patients' health (53%, = 128/241).
DISCUSSION
Access to PKU dietary treatment is frequently disrupted for reasons relating to GP prescriptions and unreliable dispensing and delivery practices. These issues require immediate attention by UK health professionals in order to create a fairer and more efficient system for everyone.
PubMed: 31709145
DOI: 10.1016/j.ymgmr.2019.100527 -
Exploratory Research in Clinical and... Jun 2022To identify and describe continuing education (CE) credit-bearing training programs for pharmacists that cover buprenorphine dispensing.
OBJECTIVES
To identify and describe continuing education (CE) credit-bearing training programs for pharmacists that cover buprenorphine dispensing.
METHODS
Five CE databases were searched for trainings that were in English, targeted to pharmacists, addressed use of buprenorphine for opioid use disorder treatment, not state-specific, accredited by the Accreditation Council for Pharmacy Education, and available for online registration.
RESULTS
Twelve trainings met the inclusion criteria. The most common topics covered were background and statistical information (10 trainings) and the clinical role of buprenorphine in medication assisted therapy (9 trainings). No training covered all 10 topics assessed. Seven programs included content on prescribing barriers, but of those, only two briefly addressed buprenorphine dispensing barriers, and none addressed the widespread belief that the Drug Enforcement Administration sets limits on the amount of buprenorphine that can be ordered and stocked. A majority of the programs (75%) addressed the clinical details of treatment, but only five addressed social barriers, such as stigma.
CONCLUSION
Future trainings should develop and increase pharmacists' awareness of content to address the gaps identified in this study so they can supplement existing trainings, especially related to DEA and wholesaler regulations and thresholds, communication, stigma, and ways of overcoming these.
PubMed: 35813287
DOI: 10.1016/j.rcsop.2022.100154 -
Aging Clinical and Experimental Research Feb 2023This study aims to analyse the impact of the pandemic on the amount of use and new medication dispensation for chronic diseases in the Italian population aged 65 years...
OBJECTIVE
This study aims to analyse the impact of the pandemic on the amount of use and new medication dispensation for chronic diseases in the Italian population aged 65 years and older (almost 14 million inhabitants).
METHODS
The "Pharmaceutical Prescriptions database", which gathers data on medications, reimbursed by the National Health Service and dispensed by community pharmacies, was employed. Data were analysed as amount of use (defined daily dose-DDD per 1000 inhabitants); variation in DDD between 2020 and 2019 was calculated for the 30 categories with major consumption in 2020. Trends in prevalence and incidence of dispensations between 2020 and 2019 were calculated for four categories: antidiabetics, antihypertensives, antidepressants and drugs for respiratory diseases.
RESULTS
All medications showed a negative variation in DDD/1000 inhabitants between 2020 and 2019 except for anticoagulants (+ 5%). The percentage variation ranged from - 27.7% for antibiotics to - 6.4% for antipsychotics in 85 + year-old persons, but increased for most classes in the youngest (65-69 years). On the other hand, a decrease of the dispensation incidence of antidiabetics, antihypertensives, antidepressants and drugs for pulmonary disease was high, especially in the two extreme age groups, the youngest and the oldest one.
CONCLUSIONS AND RELEVANCE
Great variation in medication use between 2020 and 2019 was observed probably reflecting the low rate of infectious diseases due to the widespread use of protective devices and self-isolation, reduced healthcare access because of the lockdowns and the fear of going to hospital, and the reduction of screening and diagnostics due to health-care system overload.
Topics: Humans; Aged, 80 and over; Pandemics; Antihypertensive Agents; State Medicine; COVID-19; Communicable Disease Control; Antidepressive Agents; Hypoglycemic Agents; Italy
PubMed: 36469252
DOI: 10.1007/s40520-022-02303-9 -
JAMA Internal Medicine Sep 2019Prescription opioid misuse is a public health problem that leads to overdose. Although existing interventions focus on limiting prescribing to patients at high risk,...
IMPORTANCE
Prescription opioid misuse is a public health problem that leads to overdose. Although existing interventions focus on limiting prescribing to patients at high risk, individuals may still access prescription opioids dispensed to family members.
OBJECTIVE
To determine whether opioid prescriptions to family members were associated with overdose for individuals who themselves did not have an opioid prescription.
DESIGN, SETTING, AND PARTICIPANTS
We conducted a 1:4 matched case-control study using health care utilization data from 2004 through 2015 from a large US commercial insurance company. Eligible individuals were required to have at least 12 months of continuous enrollment and 1 or more family members in the database. Individuals who experienced overdose were identified by their first opioid overdose after the baseline period and matched to control participants by time in the database, calendar time, age, sex, and number of individuals in the family unit. Both groups were restricted to individuals with no prior opioid dispensing of their own. Data analysis was conducted from January 2018 to August 2018.
EXPOSURES
Any prior opioid dispensing to a family member, total morphine milligram equivalents dispensed to family members, and the type of opioid product dispensed.
MAIN OUTCOMES AND MEASURES
Individual odds of opioid overdose resulting in an emergency department visit or hospitalization were the primary end point. The primary analysis evaluated the odds of overdose among individuals whose family members had been dispensed an opioid. Sensitivity analyses examined the odds stratified by age and timing relative to the dispensing of opioids to family members.
RESULTS
A total of 2303 individuals who experienced opioid overdose and 9212 matched control individuals were identified. The mean (SD) age was 23.2 (18.1) years; 1158 affected individuals and 4632 control individuals (50.3%) were female. The mean (SD) time in the database before an overdose case was 3.2 (3.3) years. Prior opioid dispensing to family members was associated with individual overdose (odds ratio [OR], 2.89 [95% CI, 2.59-3.23]). There was a significant dose-response association between increasing amounts of opioids dispensed to family members and odds of overdose (>0-<50 morphine milligram equivalents per day: OR, 2.71 [95% CI, 2.42-3.03]; 50-<90 morphine milligram equivalents per day: OR, 7.80 [95% CI, 3.63-16.78]; ≥90 morphine milligram equivalents per day: OR, 15.08 [95% CI, 8.66-26.27]).
CONCLUSIONS AND RELEVANCE
In this analysis, opioid prescriptions to family members were associated with overdose among individuals who do not receive opioid prescriptions. Interventions may focus on expanding access to opioid antagonists, locking prescription opioids in the home, and providing greater patient education to limit fatal overdose among family members.
PubMed: 31233088
DOI: 10.1001/jamainternmed.2019.1064