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Prevalence of Substance Misuse in New Patients in an Outpatient Psychiatry Clinic Using a Prescription Monitoring Program

Elle M. Sowa, MD; Jonathan C. Fellers, MD; Rachna S. Raisinghani, MBBS; Maria R. Santa Cruz, MD; Priscilla C. Hidalgo, MD; Meredith S. Lee, DO; Lady A. Martinez, MD; Adrienne E. Keller, PhD; and Anita H. Clayton, MD

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ABSTRACT

Objective: To investigate the value of a prescription monitoring program in identifying prescription drug misuse among patients presenting to a resident physician outpatient psychiatry clinic at an academic medical center.

Method: Participants were 314 new patients aged 18 years or older presenting to the clinic from October 2011 to June 2012. Resident physicians completed a data collection form for each participant using information from the patient interview and from the prescription monitoring program report. Prescription drug misuse was defined as having any 1 of the following 5 criteria in the prescription monitoring program report: (1) filled prescriptions for 2 or more controlled substances, (2) obtained prescriptions from 2 or more providers, (3) obtained early refills, (4) used 3 or more pharmacies, and (5) the prescription monitoring program report conflicted with the patient’s report.

Results: At least 1 indicator of prescription drug misuse was found in 41.7% of patients. Over 69% of the patients that the residents believed were misusing prescription drugs actually met 1 of the criteria for prescription drug misuse. The prescription monitoring program report changed the management only 2.2% of the time. Patients with prior benzodiazepine use (χ21 = 17.68, P < .001), prior opioid use (χ21 = 19.98, P < .001), a personality disorder (χ21 = 7.22, P < .001), and chronic pain (χ21 = 14.31, P < .001) had a higher percentage of prescription drug misuse compared to patients without these factors.

Conclusions: Using the prescription monitoring program to screen patients with prior benzodiazepine and opioid use, with a personality disorder, and/or with chronic pain may be useful in confirming the suspicion of prescription drug misuse identified at the initial evaluation.

Prim Care Companion CNS Disord 2014;16(1):doi:10.4088/PCC.13m01566

Submitted: August 3, 2013; accepted October 1, 2013.

Published online: January 2, 2014.

Corresponding author: Elle M. Sowa, MD, University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 2955 Ivy Rd, Northridge Suite 210, Charlottesville, VA 22903 (sowa@uthscsa.edu).