Use of Drugs Subject to Controlled Prescriptions: a Retrospective Analysis

Öz

Use of Drugs Subject to Controlled Prescriptions: a Retrospective Analysis

Abstract

Objective: Use of drugs that may lead to abuse or dependence are subject to controlled prescriptions (CPs) in many countries, and these are closely monitored by health authorities. According to national regulations in Turkey, CPs may be red coloured (RCPs) or green coloured (GCPs). The aim of this study was to evaluate the use of such drugs in Istanbul. Study Design: Retrospective case-control study. Material and Methods: During the study period (01/01-31/12 2009), 502874 CPs were reported. Among these, 4000 CPs each month were randomly selected and evaluated. Results: The majority of GCPs were issued to women (55.6%), while the majority of RCPs were issued to men (68.4%). GCPs were most frequently prescribed by physicians working in private hospitals (33.6%) while RCPs by physicians working in university hospitals (39.7%). GCPs were mostly prescribed by psychiatrists (37.6%) while for RCPs were child and adolescent psychiatrists (35.9%). Psycholeptics (ATC code N05) were the most prescribed controlled drugs (CDs) (43.8%). Methylphenidate (53.9%) was the mostly prescribed on RCPs and alprazolam (39.6%) was on GCPs. Conclusion: We demonstrate that utilization of CDs shows demographical and institutional differences. These data could be of help to improve surveillance of CDs as well as to train prescribers and patients. Turkish Başlık: Kontrole Tabi İlaçların Kullanımı: Retrospektif Bir Çalışma Anahtar Kelimeler: Kontrole tabi reçeteler, Kontrole tabi ilaçlar, Narkotikler, Psikotrop ilaçlar, Kırmızı ve Yeşil reçeteler Amaç: Kötüye kullanılma ya da bağımlılığa yol açma riski taşıyan ilaçlar pek çok ülkede kontrole tabidir ve kullanımları sağlık otoriteleri tarafından yakından izlenmektedir. Türkiye'deki ulusal düzenlemelere göre, çoğu kontrole tabi ilaç (KTİ) kırmızı reçete (KR) ya da yeşil reçete (YR) formatında işlem görmektedir. Çalışmada, İstanbul'da bu formatta işlem gören KTİ'lerin kullanımının araştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışma periyodu boyunca (01/01-31/12 2009), 502 874 kontrole tabi reçete (KTR) İstanbul Sağlık Müdürlüğü'ne ulaştırılmıştır. Bu reçeteler arasından, her ay için rastgele seçilen 4 000 KTR araştırmada incelenmiştir. Bulgular: YR'lerin daha çok kadınlara (%55.6), KR'lerin daha çok erkeklere (%68.4) yazıldığı saptandı. YR'lerin en sık özel hastanelerde (%33.6), KR'lerin en sık üniversite hastanelerinde (%39.7) yazıldığı saptandı. YR'lerin en fazla psikiyatri (%37.6), KR'lerin en fazla çocuk ve ergen psikiyatrisi (%35.9) uzmanları tarafından yazdığı saptandı. Psikoleptiklerin (ATC kodu: N05), (%43.8) en çok reçetelenen KTİ olduğu saptandı. En sık reçete edilmiş olan KTİ'lerin KR'lerde metilfenidat (%53.9), YR'lerde alprazolam (%39.6) olduğu saptandı. Sonuç: KTİ kullanımının demografik ve kurumsal farklılıklar gösterdiği bu araştırmayla ortaya konmuş oldu. Bu bilgilerin, KTİ takip sistemlerinin geliştirilmesinde ve bu ilaçları yazan ya da kullanan kişilere yönelik etkinliklerde yol gösterici olması beklenmektedir.

Keywords

• Controlled prescriptions, controlled medicines, narcotics, psychotropic medications, green and red coloured scripts

Kaynakça

1. United Nations. Single Convention on Narcotic Drugs, 1961, as amended by the 1972 Protocol amending the Single Convention on Narcotic Drugs, 1961. http://www.incb.org/pdf/e/conv/ convention_1961_en.pdf. Accessed:08.05.2012.
2. United Nations. Convention on Psychotropic Substances, 1971. http://www.incb.org/pdf/e/conv/convention_1971_en.pdf. Accessed:08.05.2012.
3. United Nations. Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988. http://www.incb.org/ pdf/e/conv/1988_convention_en.pdf. Accessed:08.05.2012.
4. United Nations Office on Drugs and Crime (UNODC). Ensuring availability of controlled medications for the relief of pain and preventing diversion and abuse:Striking the right balance to achieve the optimal public health outcome. Vienna, 2011.
5. Republic of Turkey The Official Gazette. Circular letter regarding the prescriptions of substances and drugs subject to control. 01985, Number:5768. [T.C Resmi Gazete Kontrole Tabi Uyuşturucu Madde ve Müstahzarların Reçeteleri Hakkında Genelge. 29 Mayıs 1985, Sayı:5768].
6. Republic of Turkey The Official Gazette. Circular letter regarding the prescriptions of psychotropic medications. 02.01.1986, Number:09/2677. [T.C Resmi Gazete Psikotrop İlaç Reçeteleri Hakkında Genelge. 02.01.1986, 09/2677].
7. World Health Organization (WHO). Improving access and use of psychotropic medicines (Mental health policy and service guidance package), 2005.
8. United Nations Office on Drugs and Crime (UNODC). World Drug Report 2011. United Nations Publication, Sales No. E.11. XI.

9. Prueksaritanond S, Tubtimtes S, Pumkompol T, Sukying C. Psychotropic drug prescribing in the family medicine out-patient clinic, Ramathibodi Hospital. J Med Assoc Thai 2009;92:266-72. Westbury JL, Jackson S, Peterson GM. Psycholeptic use in aged care homes in Tasmania, Australia. J Clin Pharm Ther 2010;35:189-93. [CrossRef]
10. Fortuna RJ, Robbins BW, Caiola E, Joynt M, Halterman JS. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics 2010;126:1108-16. [CrossRef] John U, Baumeister SE, Völzke H, Grabe HJ, Freyberger HJ, Alte D. Estimation of psycholeptic and psychoanaleptic medicine use in an adult general population sample using the Anatomical Therapeutic Chemical classification. Int J Methods Psychiatr Res 2008;17:220-31. [CrossRef]
11. Svab V, Subelj M, Vidmar G. Prescribing changes in anxiolytics and antidepressants in Slovenia. Psychiatr Danub 2011;23:178
12. McCabe SE, West BT, Teter CJ, Ross-Durow P, Young A, Boyd CJ. Characteristics associated with the diversion of controlled medications among adolescents. Drug Alcohol Depend 2011;118:452-8. [CrossRef]
13. Eggen AE. The use of controlled analgesics in a general population (15-59 years)-the influence of age, gender, morbidity, lifestyle and sociodemographic factors. Pharmacoepidemiol Drug Saf 1996;5:101-11. [CrossRef]
14. Kanavos P, Üstel İ, Font JC. Healthcare/Pharmaceutical Spending and Pharmaceutical Reimbursement Policy in Turkey. New Hope in Health Foundation (SUVAK), 2005.
15. Lieberman JA. The use of antipsychotics in primary care. Primary Care Companion J Clin Psychiatry 2003;5:3-8.
16. Ohayon MM, Caulet M, Priest RG, Guilleminault C. Psychotropic medication consumption patterns in the UK general population. J Clin Epidemiol 1998;51:273-83. [CrossRef]
17. United Nations. Report of the International Narcotics Control Board for 2010. New York, 2011. United Nations Publication Sales No. E.11.XI.1.