Prescription drug monitoring program inquiry in psychiatric assessment: Detection of high rates of opioid prescribing to a dual diagnosis population

Daniel T. Hackman, Marion S. Greene, Taya J. Fernandes, Ashley M. Brown, Eric R. Wright, R. Chambers

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: An epidemic of prescription drug abuse is disproportionately impacting the mentally ill. We examined the utility of a state prescription drug monitoring database for assessing recent controlled substance prescribing to patients presenting for dual diagnosis treatment. Method: In a community mental health center that provides integrated dual diagnosis care, we queried the Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) system for all cases that were open as of August 2, 2011, and had been practitioner-diagnosed (per DSM-IV criteria) by January 2, 2012. INSPECT provided a record of controlled substance dispensations to each patient; diagnostic evaluation was conducted blind from prescription data compilation covering the prior 12 months. Demographic data, insurance status, and DSM-IV diagnoses were compiled from the clinic's electronic medical record. Results: The sample (N = 201) was 51% female, 56% white, and two-thirds uninsured. Over 80% were dually diagnosed with substance use disorders and psychotic, mood, or anxiety disorders. Nicotine and alcohol disorders were identified in most, with about a third diagnosed with cannabis, cocaine, or opioid disorders. A majority of patients (n = 115) had been prescribed opioids in the prior year, with nearly 1 in 5 prescribed an opioid and benzodiazepine simultaneously. Patients were dispensed a mean of 4 opioid prescriptions and 213 opioid pills. More opioid prescriptions correlated with opioid dependence (OR = 1.08; 95% CI, 1.016-1.145), and more prescribers correlated with personality disorder diagnoses (OR = 1.112; 95% CI, 1.001-1.235). Higher rates and riskier patterns of controlled substance prescribing were identified in patients with Medicaid/Medicare insurance compared to uninsured patients. Conclusions: Prescription drug monitoring is a powerful tool for assessing addictions and high frequencies of patient exposures to prescribed opioids in a dual diagnosis clinic. Improved prevention and treatment strategies for addictions as facilitated by more research and clinical use of prescription drug monitoring in psychiatric care are warranted.

Original languageEnglish
Pages (from-to)750-756
Number of pages7
JournalJournal of Clinical Psychiatry
Volume75
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Dual (Psychiatry) Diagnosis
Prescription Drugs
Drug Monitoring
Opioid Analgesics
Psychiatry
Controlled Substances
Population
Electronic Prescribing
Prescriptions
Diagnostic and Statistical Manual of Mental Disorders
Prescription Drug Misuse
Pharmaceutical Databases
Psychotic Affective Disorders
Community Mental Health Centers
Insurance Coverage
Drugs
Monitoring
Prescription
Electronic Health Records
Personality Disorders

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Arts and Humanities (miscellaneous)

Cite this

Prescription drug monitoring program inquiry in psychiatric assessment : Detection of high rates of opioid prescribing to a dual diagnosis population. / Hackman, Daniel T.; Greene, Marion S.; Fernandes, Taya J.; Brown, Ashley M.; Wright, Eric R.; Chambers, R.

In: Journal of Clinical Psychiatry, Vol. 75, No. 7, 2014, p. 750-756.

Research output: Contribution to journalArticle

Hackman, Daniel T. ; Greene, Marion S. ; Fernandes, Taya J. ; Brown, Ashley M. ; Wright, Eric R. ; Chambers, R. / Prescription drug monitoring program inquiry in psychiatric assessment : Detection of high rates of opioid prescribing to a dual diagnosis population. In: Journal of Clinical Psychiatry. 2014 ; Vol. 75, No. 7. pp. 750-756.
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abstract = "Objective: An epidemic of prescription drug abuse is disproportionately impacting the mentally ill. We examined the utility of a state prescription drug monitoring database for assessing recent controlled substance prescribing to patients presenting for dual diagnosis treatment. Method: In a community mental health center that provides integrated dual diagnosis care, we queried the Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) system for all cases that were open as of August 2, 2011, and had been practitioner-diagnosed (per DSM-IV criteria) by January 2, 2012. INSPECT provided a record of controlled substance dispensations to each patient; diagnostic evaluation was conducted blind from prescription data compilation covering the prior 12 months. Demographic data, insurance status, and DSM-IV diagnoses were compiled from the clinic's electronic medical record. Results: The sample (N = 201) was 51{\%} female, 56{\%} white, and two-thirds uninsured. Over 80{\%} were dually diagnosed with substance use disorders and psychotic, mood, or anxiety disorders. Nicotine and alcohol disorders were identified in most, with about a third diagnosed with cannabis, cocaine, or opioid disorders. A majority of patients (n = 115) had been prescribed opioids in the prior year, with nearly 1 in 5 prescribed an opioid and benzodiazepine simultaneously. Patients were dispensed a mean of 4 opioid prescriptions and 213 opioid pills. More opioid prescriptions correlated with opioid dependence (OR = 1.08; 95{\%} CI, 1.016-1.145), and more prescribers correlated with personality disorder diagnoses (OR = 1.112; 95{\%} CI, 1.001-1.235). Higher rates and riskier patterns of controlled substance prescribing were identified in patients with Medicaid/Medicare insurance compared to uninsured patients. Conclusions: Prescription drug monitoring is a powerful tool for assessing addictions and high frequencies of patient exposures to prescribed opioids in a dual diagnosis clinic. Improved prevention and treatment strategies for addictions as facilitated by more research and clinical use of prescription drug monitoring in psychiatric care are warranted.",
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