Profiling multiple provider prescribing of opioids, benzodiazepines, stimulants, and anorectics

• Published in: Drug and alcohol dependence Vol. 112; no. 1; pp. 99 - 106
• Main Authors: Wilsey, B.L, Fishman, S.M, Gilson, A.M, Casamalhuapa, C, Baxi, H, Zhang, H, Li, C.S
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.11.2010; Elsevier
• Subjects: Addictive behaviors; Adult and adolescent clinical studies; Analgesics, Opioid - therapeutic use; Anorexia nervosa; Appetite depressants; Appetite Depressants - metabolism; Appetite Depressants - therapeutic use; Benzodiazepine; Benzodiazepines; Benzodiazepines - metabolism; Benzodiazepines - therapeutic use; Biological and medical sciences; Central Nervous System Agents; Central nervous system stimulants; Drug addiction; Drug Prescriptions; Eating behavior disorders; Female; Humans; Inappropriate Prescribing; Male; Medical sciences; Narcotics; Neuropharmacology; Opioids; Pharmacology. Drug treatments; Physician-Patient Relations; Polypharmacy; Practice Patterns, Physicians; Prescribing; Prescriptions; Prevalence; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Stimulants; Appetite depressants; Narcotics; Drug prescriptions; Central nervous system stimulants; Benzodiazepines; Appetite; Human; Criminalistics; Drug addiction; Multiple; CNS stimulant; Illicit drug; Opiates; Anorexia nervosa; Eating disorder; Addiction; Medical prescription; Benzodiazepine derivatives; Anorectic
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2010.05.007

Abstract Background The main objective of this study was to determine the prevalence of multiple providers for different controlled substances using the largest electronic prescription monitoring program (PMP) in the United States. A secondary objective was to explore patient and medication variables associated with prescriptions involving multiple providers. PMPs monitor the final allocation of controlled substances from pharmacist to patient. The primary purpose of this scrutiny is to diminish the utilization of multiple providers for controlled substances. Methods This is a secondary data analysis of the California PMP, the Controlled Substance Utilization Review and Evaluation System (CURES). The prevalence of multiple provider episodes was determined using data collected during 2007. A series of binomial logistic regressions was used to predict the odds ratio (OR) of multiple prescriber episodes for each generic type of controlled substance (i.e., opioid, benzodiazepine, stimulant, or diet pill (anorectic) using demographic and prescription variables. Results Opioid prescriptions (12.8%) were most frequently involved in multiple provider episodes followed by benzodiazepines (4.2%), stimulants (1.4%), and anorectics (0.9%), respectively. The greatest associations with multiple provider episodes were simultaneously receiving prescriptions for different controlled substances. Conclusions Opioids were involved in multiple provider prescribing more frequently than other controlled substances. The likelihood of using multiple providers to obtain one class of medications was substantially elevated as patients received additional categories of controlled substances from the same provider or from multiple practitioners. Polypharmacy represents a signal that requires additional vigilance to detect the potential presence of doctor shopping.