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Meperidine, safety warnings, prescribing behaviour
The use of meperidine (Demerol©) as an analgesic is associated with serious adverse effects due to its metabolism to normeperidine. National safety warnings were issued in 2004/2005.
To assess the population level and regional variation in the prescribing of meperidine and response to voluntary safety warning s in Manitoba.
A serial cross-sectional study was conducted utilizing the Manitoba Pharmacare database to determine regional patterns of use of meperidine from 2001- 2011.
The provincial quarterly Defined Daily Dose (DDD) rate dropped significantly from 10.8 to 7.9 DDD/1000 persons/quarter. Rate of use declined significantly in six of eleven regions (p<0.001) but three regions showed increased rates of use (NS). While only 4% of physicians continue to prescribe meperidine, three regions have rates of use of approximately double the provincial average.
Meperidine use has declined in Manitoba since the release of safety warnings. The majority of physicians no longer prescribe this agent for community use but a minority of prescribers contribute to regional pockets of higher use. These results point the way to future recommendations for quality improvement in meperidine use. Targeting future educational interventions to selected areas may be the best use of educational resources to further decrease use. Alternatively, policy changes to remove meperidine from provincial drug coverage may be a more effective strategy.
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