Bringing Citizen-Led Research to Life Through the Landscape of - PowerPoint PPT Presentation

Bringing Citizen-Led Research to Life Through the Landscape of Prescription on Stimulant Use Report 2019 CADTH Symposium April 15, 2019 Mina Tadrous Ontario Drug Policy Research Network www.odprn.ca @ODPRN_Research

Disclosures • I have no actual or potential conflict of interest in relation to this topic or presentation • This study was funded by: – Ontario Ministry of Health and Long Term Care (MOHLTC) Health System Research Fund (HSRF) – Ontario SPOR SUPPORT Unit – This study was also supported by ICES 2

About the ODPRN The Ontario Drug Policy Research Network Network of clinical researchers from across Ontario interested in drug policy research Launched in 2008: Funded through research grants Primary Objective: Provide high quality, relevant drug research to Ontario’s policy -makers in a timely manner on an as-needed basis

ODPRN Structure 4

Citizens’ Panel Vision To improve Ontario drug policy and healthcare through the integration of patient and citizen perspectives at all stages of the research process. Purpose • Suggest, prioritize and select research topics • Ensure relevance of research from a patient/citizen perspective • Provide input on proposed policy recommendations • Contextualize research findings • Advise and support dissemination strategies through personal and professional networks 4/23/2019 5

Meet the Citizen’s Panel 4/23/2019 6

Membership Expectations • 18-22 members to-date • Attend bi-monthly meetings – 63% average attendance • Attend annual in-person rate meeting • Term of Office – ~2 years – Option for renewal 4/23/2019 7

Representation Age groups 18 - 25 5% 66 - 75 10% 56 - 65 15% 26 - 35 35% 46 - 55 20% 36 - 45 15% Gender Male 35% Female 65% 4/23/2019 8

Representation Professional Background Cultural/Ethnic Background Black Caribbean/Af rican/African Canadian 14% Latin American 9% South Asian 10% White [PERCENTAG E] 4/23/2019 9

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PANEL-LED PROJECT Landscape of Prescription Stimulant Use in Ontario 4/23/2019 12

Stimulants • Controlled substance commonly used treatment of ADHD – Increase in utilization, especially in the adult population – Concern over safety – Misuse/diversion, cardiovascular concerns, long-term impact • Patient expectation of differences between brand and generics Generic name Tradename Amphetamine mixture Adderall XR (+ generics) Dextro-amphetamine Dexedrine, Dexedrine Spansule Lis-dexamfetamine Vyvanse Methylphenidate Concerta (+ generics) Ritalin , Ritalin SR (+generics) Biphentin 4/23/2019 13

Process Identify • Mental health and addiction Topic Develop • Sub-committee Process Design • Proposed methods and Refine 4/23/2019 14

Process Design and Refine Analyze and • Developed key messages Interpret • Methods Report and • Future Evaluate research 4/23/2019 15

Landscape of Prescription Stimulant Use 4/23/2019 16

Landscape of Prescription Stimulant Use 17

Interpreting Results 18

Landscape of Prescription Stimulant Use 4/23/2019 19

Landscape of Prescription Stimulant Use Uptake Metrics Page views 1,107 Number of users 699 Average time on page 2 min 51 sec 4/23/2019 20

Lessons Learned Facilitators Barriers • Developed important • Representative questions relevant to population Insights citizens • Improves knowledge of • Resource and time public access to certain intensive drugs • Determines research • Background knowledge priorities of joint interest and contextualizing the to policymakers and research general public 4/23/2019 21

Acknowledgments Tara Gomes Report Citation: St Michael’s Hospital • Martins D, Greaves S, Tadrous M, Shearer D, Dana Shearer et al on behalf of the ODPRN Citizens’ St Michael’s Hospital Panel. Landscape of Prescription Stimulant Diana Martins Use: Patterns, Trends and Geographic St Michael’s Hospital Variation in Ontario, Canada. Toronto: Ontario Drug Policy Research Network; Samantha Singh September 2018. ICES David N. Juurlink Sunnybrook Research Institute Muhammad M. Mamdani St Michael’s Hospital 22

Extra slides 4/23/2019 23

Interpreting Results Characteristics of Stimulant Users in 2016 Prevalent User New User Characteristic Total (N=168,514) (N=118,561) (N=49,953) 0-18 57,897 (48.8%) 21,359 (42.8%) 79,256 (47.0%) 19-24 14,859 (12.5%) 8,034 (16.1%) 22,893 (13.6%) 24-44 26,012 (21.9%) 12,931 (25.9%) 38,943 (23.1%) Age group 45-64 16,849 (14.2%) 6,049 (12.1%) 22,898 (13.6%) 65+ 2,795 (2.4%) 1,426 (2.9%) 4,221 (2.5%) Missing 149 (0.1%) 154 (0.3%) 303 (0.2%) Male 76,205 (64.3%) 30,056 (60.2%) 106,261 (63.1%) Female 42,207 (35.6%) 19,743 (39.5%) 61,950 (36.8%) Sex Missing 149 (0.1%) 154 (0.3%) 303 (0.2%) Long acting 106,126 (89.5%) 43,633 (87.3%) 149,759 (88.9%) Formulation Dispensed Immediate release 12,435 (10.5%) 6,320 (12.7%) 18,755 (11.1%) Dextroamphetamine 7,399 (6.2%) 1,859 (3.7%) 9,258 (5.5%) Lisdexamfetamine 32,852 (27.7%) 15,492 (31.0%) 48,344 (28.7%) Stimulant Dispensed Methylphenidate 72,996 (61.6%) 32,169 (64.4%) 105,165 (62.4%) Mixed-Salt Amphetamine 17,819 (15.0%) 6,545 (13.1%) 24,364 (14.5%) Psychiatrist 20,548 (17.3%) 12,790 (25.6%) 33,338 (19.8%) Pediatrician 22,359 (18.9%) 10,900 (21.8%) 33,259 (19.7%) Recent physician visit General/Family Physician 59,652 (50.3%) 34,846 (69.8%) 94,498 (56.1%) Specialist 71,211 (60.1%) 30,955 (62.0%) 102,166 (60.6%) General/Family Physician 58,788 (49.6%) 24,414 (48.9%) 83,202 (49.4%) Psychiatrist 21,545 (18.2%) 11,026 (22.1%) 32,571 (19.3%) Pediatrician 32,874 (27.7%) 11,051 (22.1%) 43,925 (26.1%) Initial prescriber Missing 2,361 (2.0%) 1,703 (3.4%) 4,064 (2.4%) 24 Other 2,993 (2.5%) 1,759 (3.5%) 4,752 (2.8%)

Interpreting Results Characteristics of Stimulant Users in 2016, by Age Total Age 0-18 Age 19-24 Age 25-44 Age 45-64 Age 65+ Characteristic (N=168,514) (N=79,256) (N=22,893) (N=38,943) (N=22,898) (N=4,221) Male 106,261 (63.1%) 57,838 (73.0%) 13,830 (60.4%) 21,450 (55.1%) 11,031 (48.2%) 2,112 (50.0%) Female 61,950 (36.8%) 21,418 (27.0%) 9,063 (39.6%) 17,493 (44.9%) 11,867 (51.8%) 2,109 (50.0%) Sex Missing 303 (0.2%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Psychiatrist 33,338 (19.8%) 10,139 (12.8%) 4,652 (20.3%) 10,428 (26.8%) 7,181 (31.4%) 938 (22.2%) Pediatrician 33,259 (19.7%) 32,130 (40.5%) N/A N/A N/A N/A Recent physician visit General/Family Physician 94,498 (56.1%) 32,536 (41.1%) 15,531 (67.8%) 27,386 (70.3%) 16,014 (69.9%) 3,031 (71.8%) Specialist 102,166 (60.6%) 58,011 (73.2%) 9,013 (39.4%) 18,510 (47.5%) 13,543 (59.1%) 2,929 (69.4%) General/Family Physician 83,202 (49.4%) 24,319 (30.7%) 16,203 (70.8%) 25,923 (66.6%) 13,865 (60.6%) 2,757 (65.3%) Psychiatrist 32,571 (19.3%) 9,302 (11.7%) 4,600 (20.1%) 10,316 (26.5%) 7,362 (32.2%) 934 (22.1%) Pediatrician 43,925 (26.1%) 42,234 (53.3%) N/A N/A N/A N/A Initial prescriber Missing 4,064 (2.4%) 1,789 (2.3%) 612 (2.7%) 989 (2.5%) 543 (2.4%) 123 (2.9%) Other 4,752 (2.8%) 1,612 (2.0%) 499 (2.2%) 1,302 (3.3%) 941 (4.1%) 389 (9.2%) Any NMS warning flag in 2016 18,047 (10.7%) 5,688 (7.2%) 2,183 (9.5%) 6,057 (15.6%) 3,380 (14.8%) 716 (17.0%) Early re-fill 13,314 (7.9%) 5,308 (6.7%) 1,727 (7.5%) 3,681 (9.5%) 2,072 (9.0%) 507 (12.0%) Double doctoring 5,512 (3.3%) 415 (0.5%) 491 (2.1%) 2,821 (7.2%) 1,527 (6.7%) 253 (6.0%) Potential Inappropriate Poly-pharmacy 2,275 (1.4%) 125 (0.2%) 259 (1.1%) 1,396 (3.6%) 451 (2.0%) 44 (1.0%) Use Opioid prescription in 2016 28,138 (16.7%) 3,763 (4.7%) 3,415 (14.9%) 10,582 (27.2%) 8,460 (36.9%) 1,886 (44.7%) >3 stimulant prescriptions and >3 opioid prescriptions in 2016 10,497 (6.2%) 80 (0.1%) 519 (2.3%) 4,959 (12.7%) 4,192 (18.3%) 741 (17.6%)

Interpreting Results Rate of stimulant users by Public Health Unit (PHU) 25 20 Rate per 1000 population 15 10 5 0 26

Interpreting Results Rate of stimulant users by Local Health Integration Unit (LHIN) 20 18 16 14 Rate per 1000 population 12 10 8 6 4 2 0 Erie St. South West Waterloo Hamilton Central Mississauga Toronto Central Central South East Champlain North North East North West Clair Wellington Niagara West Halton Central East Simcoe Haldimand Muskoka 27 Brant