Harmonizing post-market surveillance of prescription drug misuse: A systematic review of observational studies using routinely collected data (2000–2013)

Abstract

Background Prescription drug misuse is a growing public health concern globally. Routinely collected data provides a valuable tool for quantifying prescription drug misuse. Objective To synthesize the global literature investigating prescription drug misuse utilizing routinely collected, person-level prescription/dispensing data to examine reported measures, documented extent of misuse and associated factors. Methods We searched MEDLINE, Embase, CINAHL, MEDLINE In Process, Scopus citations and Google Scholar for relevant articles published between January 1 2000-July 31 2013. We screened 10,803 abstracts and retrieved 281 full-text manuscripts. Fifty-two peer-reviewed, English-language manuscripts met our inclusion criteria: an aim/method investigating prescription drug misuse and a measure of misuse derived exclusively from prescription/dispensing data. Results Four proxies of prescription drug misuse were used commonly across studies: number of prescribers, dispensing pharmacies, early refills and volume of drugs dispensed. We identified 89 unique measures of misuse across the 52 studies, reflecting the heterogeneity in how measures are constructed; single or composite; different thresholds, cohort definitions and time period of assessment. Consequently, it was not possible to make definitive comparisons about the extent (range reported: 0.01-93.5%), variations and factors associated with prescription drug misuse. Conclusion Routine data collections are relatively consistent across jurisdictions. Despite the heterogeneity of the current literature, our review identifies the capacity to develop universally accepted metrics of misuse applied to a core set of variables in prescription/dispensing claims. Our timely recommendations have the potential to unify the global research field and increase the capacity for routine surveillance of prescription drug misuse.