Polypharmacy of potentially addictive medication in the older persons-quantifying usage
Department of Epidemiology and Community Medicine, Faculty of Medicine University of Ottawa, Ottawa, Canada. Pharmacoepidemiology and Drug Safety
(Impact Factor: 2.94).
02/2012; 21(2):199-206. DOI: 10.1002/pds.2214
The use of restricted medications, for example, opioids, benzodiazepines (BZD), and z-hypnotics, in the older persons continues to increase. Little is known about usage practices or about the extent of polypharmacy within this group. The objectives of this study were (i) to describe polypharmacy and (ii) to develop a medication usage index (MUI) to quantify usage patterns.
Data for 2008 were obtained from the Norwegian Prescription Database containing all prescriptions filled in Norwegian pharmacies. The study population included people aged 70-89 years who filled prescriptions for weak opioids, strong opioids, anxiolytic BZD, hypnotic BZD, and/or z-hypnotics. A MUI was developed based on Anatomical Therapeutic Chemical codes, defined daily doses, Anatomical Therapeutic Chemical subgroups, and number of prescribers.
Forty-two percent of elderly Norwegians filled at least one prescription in one of the medication subgroups in 2008. MUI Level 1 (least) usage was shown by 56.6% of users (23.8% of the general population), Level 2 by 29.7% (12.5%), Level 3 by 11.3% (4.8%), and Level 4 (most) by 2.4% (1.0%). People using strong opioids were the most likely to use other restricted medications. In addition, female participants had a higher MUI than did male participants, and older users higher than younger users. Cancer or palliative care patients attained twice the MUI points than did the others.
Polypharmacy was found to be common within these restricted drug categories for the older persons. MUI provides a convenient approach to summarizing drug usage and will be useful in detecting trends and regional differences and determining the impact of interventions.
Available from: Fridtjof Heyerdahl
- "The consistent increase in medication load with age is in keeping with the observed polypharmacy in the older population at large ,  and the comparatively extensive use of opioids among the elderly , reflecting in part increased morbidity with age. Whilst no doubt motivated by and in many cases helpful in patients with high comorbidity, other non-medical factors contributing to polypharmacy, e.g., doctor-patient interaction, are less well understood. "
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Patients with a history of deliberate self-poisoning (DSP) are prescribed a greater amount of medication than the general public. DSP is the most robust risk factor for repeat episodes of DSP and subsequent death by suicide, and one might therefore expect that access to prescribed medication would be reduced following an episode of DSP. However, it is unclear whether access to prescribed medication changes after an episode of DSP. The objectives of this study were to investigate changes in 1) overall, psychotropic, non-psychotropic and the psychotropic subgroup antidepressant prescribed medication availability in DSP patients following an episode of DSP, 2) prescribing of the medication ingested in the episode, and 3) potential effects of gender, age and repeater status on such change.
The design was longitudinal. We included 171 patients admitted for DSP between January 2006 and March 2007. Data on patients' prescriptions prior to admission were retrieved from The Norwegian Prescription Database. The outcome measure was the difference between medication load in the year following compared to the year prior to the DSP episode.
There was a significant increase in total medication load following DSP, including both psychotropic and non-psychotropic medication. Antidepressant medication load remained stable. There was a tendency for access to drugs ingested in the episode to increase following the episode, albeit not significantly. Medication load increased with age across all medication groups irrespective of time period and gender.
The findings show that physicians do not curb prescribing to patients who have recently deliberately self-poisoned. Moreover, they highlight the need for cautious and judicious prescribing for these patients, in combination with psychological and social interventions.
PLoS ONE 05/2014; 9(5):e98086. DOI:10.1371/journal.pone.0098086 · 3.23 Impact Factor
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Exact information on drug use is important information at admittance to hospital departments. The aim of this study was to validate the information given in the referral regarding benzodiazepine use by analysis of serum samples.
A total of 241 patients were included at admittance to a geriatric psychiatry department. Information on use of benzodiazepines according to the referral was recorded, and serum samples were analysed for benzodiazepine drugs. The number of patients with incorrect information in the referral was calculated for each benzodiazepine.
Information on benzodiazepine use was included in 60 % of patient referrals. However, serum analyses revealed the use of different or additional benzodiazepines compared with the referral information in 24 % of the patients. In 10 % of the patients, a benzodiazepine was detected despite no information on benzodiazepine use at all in the referral. For diazepam, 70 % of users were identified by serum analyses only, while this number was lower for the other benzodiazepines.
This study shows that benzodiazepine use is widespread in geriatric psychiatry, but that information about the use of these drugs is very often incorrect. This may have significant clinical consequences if symptoms caused by use or abrupt cessation of benzodiazepines are misinterpreted.
Drugs & Aging 01/2013; 30(2). DOI:10.1007/s40266-012-0045-9 · 2.84 Impact Factor
Available from: Liang-Jen Wang
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Use of anxiolytics-hypnotics, including benzodiazepines and "z" hypnotics, is a public health concern. This study aimed to investigate the trends in prevalence of anxiolytic-hypnotic drug use and polypharmacy (simultaneous use of two or more anxiolytics-hypnotics) in Taiwan.
A dynamic sample of one million individuals who were randomly selected from the National Health Insurance database was used to detect populationwide trends in the use of anxiolytics-hypnotics in Taiwan between 2002 and 2009. The analyses included drugs that are administered orally, intravenously, or intramuscularly as well as single or compound drugs. The authors identified the number of individuals who used the drugs, the sum of days of reported drug use for all individuals (person-days), and the distribution of anxiolytic-hypnotic polypharmacy for all claims for ambulatory, pharmacy, and hospital care.
Annual prevalence of any anxiolytic-hypnotic use in Taiwan was higher than 20%. The number of person-days greatly increased from 2002 (4.0%) to 2009 (6.6%). The increases in use between 2002 and 2009 were greatest for clonazepam (prevalence, 7% versus 1.8%; person-days, .2% versus .6%) and zolpidem (prevalence, 2.4% versus 4.2%; person-days, .5% versus 1.5%). Polypharmacy accounted for almost 70% of all person-days of anxiolytic-hypnotic use.
This nationwide, population-based survey presents real-world epidemiological evidence about anxiolytic-hypnotic use. The adverse effects of the long-term use of anxiolytics-hypnotics have been established, and unnecessary use of these drugs, particularly in polypharmacy regimens, should be avoided.
Psychiatric services (Washington, D.C.) 11/2013; 65(2). DOI:10.1176/appi.ps.201300066 · 2.41 Impact Factor
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