There’s a drug problem in Canada. Part of it involves the recreational misuse of drugs, but another large aspect stems from drugs that doctors prescribe as treatment. Utilizing drugs for their unintended purposes cause deaths and health consequences throughout the country. Termed “off-label” prescriptions, a study from McGill released last April found that 11 per cent of prescriptions are used to treat illnesses for which they haven’t been approved by Health Canada.
The McGill study used the Medical Office of the XXI Century (MOXXI) electronic health records in Quebec to document and link treatment indication to the prescribed drug. The McGill researchers found the underlying causes for off-label prescription to likely be doctors’ lack of knowledge about drugs, and a scarcity of approved or effective medication. It was also found that anticonvulsants (66 per cent), antipsychotics (44 per cent), and antidepressants (33 per cent) are the most commonly used drugs for unregulated purposes. For example, anxiety medication may be prescribed to treat someone with insomnia.
Dr. Robyn Tamblyn, scientific director of the Canadian Institutes of Health Research (CIHR), and a researcher here at McGill, recognizes that off-label prescriptions are a reality in the health care system, but thinks that there is insufficient research on the topic. Further inquiry is important, she says, because of the drugs’ potentially lethal side effects. The drug tiagabine, for instance, is an anti-convulsive medication, meant to treat seizures; but when used as a treatment for pain, it has the side effect of causing seizures. Another example is a treatment for acne, which has been linked to nine deaths in Canada since 2000 when used as birth control.
At the Senate committee on Social Affairs, Science and Technology earlier this month, Tamblyn proposed the idea of a monitoring system for regulating drug prescriptions. Despite previous rejection for regulation by Health Canada, Tamblyn will propose the idea to the body again later this month. A major impediment to creating a monitoring system is that, in most provinces, save for Quebec, doctors are not required to indicate what a prescription is for. A monitoring system in the works would require doctors and pharmacists to make note of whether a drug is off-label, and the reason for prescribing it. Provinces already keep administrative data of which drugs are dispensed to the population. However, some sort of overarching national-level cooperation is crucial to developing this monitoring system. Allowing the provincial databases to share information would help researchers track the effects of drugs, such as if they have negative side effects, or could potentially treat a different condition.
From a financial perspective, creating a database may be beneficial for the provinces. Sharing information on the side effects of drugs will allow doctors to avoid causing unintended harm through drug prescription, and allow them to make better use of the resources already at their disposal.
“It will give us a very novel way of looking at the safety and effectiveness of drugs,” said a contributing McGill researcher, Dr. Tewodros Equale, in an interview for AlumniOnlineCommunity.
Regulation of off-label prescriptions could lead to the next big medical breakthrough; but the bottom line is that regulating off label prescriptions will help protect the health of Canadians.