Abstract
BackgroundPrescription drug sales may vary considerably across regions and over time. This study aimed to assess whether there is an association between mean drug sales and prevalence of excessive use in a range of psychotropic prescription drugs with an abuse potential, and if so, whether the variation in mean drug sales mostly reflects variation in the prevalence of excessive use or mostly reflects variation in non-excessive use.MethodsData on all filled prescriptions taken from the Norwegian prescription database for 10 drugs with an abuse potential (pain relievers, anxiolytics, and hypnotics) during one calendar year (2005) in Norway (n = 4 053 624) included number of defined daily doses (DDD). These were aggregated to individual level (n = 815 836) and county level (n = 19).ResultsAnalyses of individual level data showed that the distribution of drug use was skewed; those who used more than 365 DDD per year accounted for almost half of the sales of both anxiolytics and hypnotics. At the county level, the mean sales per inhabitant and the prevalence of excessive users were closely correlated, but both prevalence of non-excessive use and prevalence of excessive drug use were associated with the county-wise variation in mean drug sales.ConclusionDespite a strong individual control of access to psychotropic drugs through health personnel’ prescribing, a small proportion of users account for a large fraction of the sales of these drugs. The sales vary significantly between regions and this variation is closely associated with the prevalence of excessive users. This suggests that sales figures as such may be used as an indicator to monitor variations in excessive use between regions and over time, and to evaluate interventions targeting over-prescription and excessive use.
Highlights
Prescription drug sales may vary considerably across regions and over time
For each prescription the following data were collected and used in the present analyses: patients’ unique identifiers, county of residence, and drug information; i.e. which drug based on the anatomical–therapeutic–chemical code (ATC-code) and the amount of the drug prescribed converted into number of defined daily doses (DDD)
In line with the skew distributions we observed that a substantial proportion of users filled prescriptions exceeding 365 DDD per year, this proportion was high for hypnotics (Table 2)
Summary
Prescription drug sales may vary considerably across regions and over time. In high income countries these drugs are widely used, they have a potential for abuse and are used in excessive and non-therapeutic amounts by some patients [1,2,3]. Such excessive long-term use carries an elevated risk of many and diverse negative consequences. The prescribing of opioids, hypnotics and anxiolytics varies enormously between countries, but a significant variation within countries is observed, both between regions and over time [12]. Most often a prescription system will allow for generating wholesale statistics of drug sales at the aggregate level, but it would be important to know whether – or to what extent – the aggregate variation in these sales is indicative of variation in the prevalence of excessive use and abuse of these drugs
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