Who is prescribing controlled medications to patients who die of prescription drug abuse?

Lev, Roneet; Lee, Oren; Petro, Sean; Lucas, Jonathan; Castillo, Edward M.; Vilke, Gary M.; Coyne, Christopher J.

doi:10.1016/j.ajem.2015.09.003

Cited by 80 publications

(61 citation statements)

References 16 publications

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“…One study examined the PDMP of more than 200 patients in San Diego whose deaths involved prescription drugs and found that less than a third qualified as “doctor shoppers.” However, almost three‐quarters had PDMP data in the year before their deaths, with frequent listings of hydrocodone, oxycodone, alprazolam, and clonazepam. Although it is possible that more consistent use of PDMPs could have prevented at least some of these overdoses, an appreciable subset of patients were procuring prescription agents from sources not covered by the California PDMP . Similarly, only a quarter of individuals arrested for trafficking Schedule II–IV drugs were found to have been prescribed those agents in the Maine PDMP.…”

Section: Discussionmentioning

confidence: 99%

“…Although it is possible that more consistent use of PDMPs could have prevented at least some of these overdoses, an appreciable subset of patients were procuring prescription agents from sources not covered by the California PDMP. 12 Similarly, only a quarter of individuals arrested for trafficking Schedule II-IV drugs were found to have been prescribed those agents in the Maine PDMP. Further, more than half were receiving controlled prescription drugs from only one physician and one pharmacy, whereas only 14% and 7% used three or more prescribers and pharmacies, respectively.…”

Section: Discussionmentioning

confidence: 99%

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A New Tool to Tackle the Opioid Epidemic: Description, Utility, and Results from the Maine Diversion Alert Program

Piper

Desrosiers²,

Fisher

et al. 2017

Pharmacotherapy

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Study Objective The opioid epidemic continues to impact the United States, and new strategies are needed to combat this epidemic. The objective of this study was to analyze 2015 drug arrest data from Maine’s Diversion Alert program (diversionalert.org), compare arrest data between the first quarters of 2015 and 2016, and provide an analysis of the sex differences in the arrests as well as information about DA use. Study Design A population-based, descriptive study using data from the Maine Diversion Alert Program. The study population consisted of persons arrested for prescription, non-prescription or illicit drugs. Data Source Diversion Alert database. Measurements and Main Results The Diversion Alert program addresses Maine’s prescription drug abuse epidemic with innovative resources that provide access to drug arrest data for health care providers to identify and respond to patients at risk for overdose, those engaged in illegal prescription drug distribution, and those who are in need of treatment. Drug arrest data from 2015 (2,723 arrests) and the first quarter of 2016 (788 arrests) were compared and analyzed. The drugs implicated in the arrests were organized by Drug Enforcement Agency Schedule category and whether they were pharmaceuticals (synthesized and distributed by a pharmaceutical company) or nonpharmaceuticals (grown or synthesized in clandestine laboratories). The majority of arrests were for possession (64.5%) followed by trafficking (23.8%). Heroin was listed in over three quarters (76.4%) of the Schedule I arrests, followed by marijuana (11.7%) and “bath salts” (6.3%). Cocaine and crack cocaine were implicated in almost half (46.7%) of the Schedule II arrests, followed by oxycodone (21.0%) and methamphetamine/amphetamine (15.8%). Buprenorphine was responsible for almost all (96.7%) of the Schedule III arrests. The benzodiazepines alprazolam (34.3%), clonazepam (33.8%), diazepam (11.9%), and lorazepam (8.5%) were listed in the preponderance of the Schedule IV arrests. Arrests increased in 2016 by 49.2% for heroin (p<0.01) and 170.0% for methamphetamine (p≤0.0005) relative to 2015. Arrests for trafficking increased by 42.9% (p<0.05). Males outnumbered females 2:1 in DA. Schedule IV agents accounted for only 6.8% of arrests for males versus 11.5% for females (p≤0.0001). Conversely, Schedule I agents were implicated in 33.0% of arrests for males versus only 27.3% for females (p<0.005). Conclusion Diversion Alert is an important tool for providing timely information for health care providers regarding individuals with a history of past misuse of psychotherapeutic agents, particularly opioids and stimulants.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A New Tool to Tackle the Opioid Epidemic: Description, Utility, and Results from the Maine Diversion Alert Program

Piper

Desrosiers²,

Fisher

et al. 2017

Pharmacotherapy

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“…Multiple factors have contributed to this opioid overdose epidemic, including availability of prescription and illicit opioids, unsafe prescribing of opioids, doctor shopping for opioids, and opiate diversion (Lev et al, 2016; Paulozzi, 2012). Opioid addiction is a chronic disease that often requires MAT for an adequate duration to facilitate recovery (Kampman and Jarvis, 2015; Volkow and McLellan, 2016).…”

Section: Introductionmentioning

confidence: 99%

Treatment utilization among persons with opioid use disorder in the United States

Zhu

Swartz

2016

Drug and Alcohol Dependence

301

176

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Background The United States is experiencing an opioid overdose epidemic. Treatment use data from diverse racial/ethnic groups with opioid use disorder (OUD) are needed to inform treatment expansion efforts. Methods We examined demographic characteristics and behavioral health of persons aged ≥12 years that met criteria for past-year OUD (n=6,125) in the 2005–2013 National Surveys on Drug Use and Health (N=503,101). We determined the prevalence and correlates of past-year use of alcohol/drug use treatment and opioid-specific treatment to inform efforts for improving OUD treatment. Results Among persons with OUD, 81.93% had prescription (Rx) OUD only, 9.75% had heroin use disorder (HUD) only, and 8.32% had Rx OUD+HUD. Persons with Rx OUD+HUD tended to be white, adults aged 18–49, males, or uninsured. The majority (80.09%) of persons with OUD had another substance use disorder (SUD), and major depressive episode (MDE) was common (28.74%). Of persons with OUD, 26.19% used any alcohol or drug use treatment, and 19.44% used opioid-specific treatment. Adolescents, the uninsured, blacks, native-Hawaiians/Pacific-Islanders/Asian-Americans, persons with Rx OUD only, and persons without MDE or SUD particularly underutilized opioid-specific treatment. Among alcohol/drug use treatment users, self-help group and outpatient rehabilitation treatment were commonly used services. Conclusions Most people with OUD report no use of OUD treatment. Multifaceted interventions, including efforts to access insurance coverage, are required to change attitudes and knowledge towards addiction treatment in order to develop a supportive culture and infrastructure to enable treatment-seeking. Outreach efforts could target adolescents, minority groups, and the uninsured to improve access to treatment.

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“…A number of studies demonstrate that patients discharged from surgical units leave significant quantities of their opioid analgesia unused and stored in the home . There is evidence that ED opioid analgesic prescribing leads to recurrent opioid use in the community and is a source of the prescription opioids implicated in many unintentional overdose deaths …”

Section: Introductionmentioning

confidence: 99%

Modifying emergency department electronic prescribing for outpatient opioid analgesia

Schwartz

Harding

Donaldson

et al. 2018

Emerg Medicine Australasia

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Objectives The aim of this study was to examine how changing the electronic ordering sequences for opioid analgesics affected ED outpatient prescribing, and subsequent unused opioid tablets remaining in the community available for diversion. Methods A descriptive before and after study in adult patients prescribed an opioid analgesic by an ED prescriber for use in the outpatient setting. The hospital electronic prescribing system (FirstNet™) was modified to include smaller quantities of opioid analgesics for discharge. The change in quantity of opioid prescribed and change in quantity of opioid analgesic remaining in the community at follow up was measured pre‐ and post‐intervention using a structured telephone interview. Results Pre‐ and post‐intervention, 102 and 106 patients were interviewed, respectively. Percentage of prescriptions for oxycodone quantity five tablets increased from 3% to 32% and for quantity 20 tablets fell from 40% to 24% post‐intervention. For paracetamol with codeine, prescriptions for quantity 10 tablets increased from 2% to 24% while for quantity 20 tablets fell from 98% to 76%. Mean number of tablets prescribed per patient fell from 13.8 (SD = 5.1) to 10.8 (SD = 5.6) for oxycodone and from 19.8 (SD = 1.5) to 17.6 (SD = 4.2) for paracetamol with codeine. Fifty‐eight percent of patients in both pre‐ and post‐intervention groups used half or less of the medication prescribed. Conclusion Modification of an ED electronic prescribing system reduced overall quantities of opioid analgesics supplied and subsequently stored in the community but did not change the proportion of patients (>50%) who reported using half or less of their prescribed opioid medication.

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Who is prescribing controlled medications to patients who die of prescription drug abuse?

Cited by 80 publications

References 16 publications

A New Tool to Tackle the Opioid Epidemic: Description, Utility, and Results from the Maine Diversion Alert Program

A New Tool to Tackle the Opioid Epidemic: Description, Utility, and Results from the Maine Diversion Alert Program

Treatment utilization among persons with opioid use disorder in the United States

Modifying emergency department electronic prescribing for outpatient opioid analgesia

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