| Title |
Voluntary warnings and the limits of good prescribing behavior: the case for de-adoption of meperidine
|
|---|---|
| Published in |
Journal of Pain Research, December 2015
|
| DOI | 10.2147/jpr.s96625 |
| Pubmed ID | |
| Authors |
Kevin J Friesen, Jamie Falk, Shawn Bugden |
| Abstract |
Meperidine (pethidine) offers little to no therapeutic advantage over other opioids, may be more prone to abuse, and produces a neurotoxic metabolite with a long half-life. The Institute for Safe Medication Practices (ISMP) issued warnings in 2004 and 2005 suggesting that meperidine be avoided, and when used, it should be in limited doses (<600 mg/24 h) and for a limited duration (<48 hours). Hospitals have responded to these warnings, but much less is known about meperidine prescribing in the community setting. This study examined the potential impact of ISMP warnings on the prescribing of meperidine using time series analysis. A population-based longitudinal cross-sectional study was conducted to examine oral meperidine utilization among persons 16 years of age and older in Manitoba, Canada, between April 1, 2001 and March 31, 2014. Amounts of meperidine were expressed using defined daily doses (DDDs), the equivalent of 400 mg of meperidine per day. The number of meperidine prescriptions and users per quarter were determined and analyzed using regression analysis. There were 49,063 prescriptions for 442,641 DDDs of meperidine dispensed to 9,374 distinct users. The number of DDDs of meperidine per 1,000 persons peaked in the second quarter of 2003 at 11.75, and then dropped to a low of 5.36 by 2014. This represented a marked decline in the numbers of users and prescriptions over the study period. The piecewise regression model revealed a significant breakpoint in the last quarter of 2004 (F (3, 48)=337.00, P<0.0001). In contrast to these findings, among the remaining users, there was an increase in the amount of meperidine per prescription (increase of 0.34 DDDs/prescription/year; F(1, 50)=434, P<0.0001, R (2)=0.89) and the amount of meperidine per user (increase of 1.17 DDDs/user/year; F(1, 50)=653.5, P<0.0001, R (2)=0.93). Following the ISMP warnings, meperidine use dramatically declined. Unfortunately, the remaining users of meperidine are using more meperidine and receiving more meperidine in each prescription. This pattern of results suggests that there may be limits to voluntary safety warnings. Policy action such as removal of medication insurance coverage may represent a logical next step to reverse or de-adopt meperidine and further enhance patient safety. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 18 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 18 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 4 | 22% |
| Researcher | 3 | 17% |
| Professor > Associate Professor | 2 | 11% |
| Student > Ph. D. Student | 1 | 6% |
| Librarian | 1 | 6% |
| Other | 2 | 11% |
| Unknown | 5 | 28% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 4 | 22% |
| Pharmacology, Toxicology and Pharmaceutical Science | 2 | 11% |
| Nursing and Health Professions | 2 | 11% |
| Economics, Econometrics and Finance | 1 | 6% |
| Computer Science | 1 | 6% |
| Other | 2 | 11% |
| Unknown | 6 | 33% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 18 December 2015.
All research outputs
#20,823,121
of 25,584,565 outputs
Outputs from Journal of Pain Research
#1,572
of 1,969 outputs
Outputs of similar age
#292,697
of 396,604 outputs
Outputs of similar age from Journal of Pain Research
#13
of 13 outputs
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