Addition of objective data to identify risk for medication misuse and abuse: the inconsistency score.
OBJECTIVE
To identify and quantify the rate of aberrant drug-taking behaviors using objective data.


METHODS
Institutional Review Board-approved anonymous, voluntary, quality improvement project.


METHODS
University-based, multidisciplinary pain management center.


METHODS
Consecutive initial visit patients.


METHODS
Patients were interviewed, asked to provide a urine sample, and filled out a brief questionnaire about recent prescription, over-the-counter, and illicit drug use. Discrepancies between patient report (PQ), the Virginia State prescription monitoring program (PMP), referring physician records (MRs), and the point-of-care urine drug screen (POC UDS) results were scored from 0 (none) to a maximum of 2 points (2+ discrepancies) for each potential comparator between data sets. Maximum potential inconsistency score (IS) was 16 points.


RESULTS
Two hundred nine patients were interviewed to yield 118 specimens. Mean age of participants was 48.2 years (22-83 year); 65.3% were female. IS scores ranged from 1 to 11, and 52.5% of the patients had an IS ≥ 3. Higher IS scores correlated with higher numbers of pharmacies, prescribing physicians, prescriptions on the PMP, and presence of illicit substances in the urine. Addition of either POC UDS or PMP to PQ and MR increased identification of inconsistencies by >400%, and PMP plus UDS by >900%.


CONCLUSIONS
Patient report and the medical record are inadequate to screen for aberrant drug-related behaviors. Addition of PMP and POC UDS contribute significantly to identification of inconsistencies through higher IS scores and differentiate patients at higher risk of medication misuse, abuse, or diversion. Comparison of multiple sources of objective information provides better insight into inconsistencies of report and behavior, and may assist in more appropriate and safer prescribing decisions.
Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Division of Pain Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
Robin J
RJ
Hamill-Ruth
Kylyana
K
Larriviere
Mary G
MG
McMasters
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis*; D055815:Young Adult
Benzodiazepines; Chronic Pain; Drug Abuse; Drug Misuse; Opioids; Prescription Monitoring Program; Risk Mitigation; Urine Drug Testing