title: Prevalence of substance misuse in new patients in an outpatient psychiatry clinic using a prescription monitoring program.
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.
  
  
  METHODS
  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 (χ(2) 1 = 17.68, P < .001), prior opioid use (χ(2) 1 = 19.98, P < .001), a personality disorder (χ(2) 1 = 7.22, P < .001), and chronic pain (χ(2) 1 = 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.
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville (Drs Sowa, Santa Cruz, Hidalgo, Lee, and Clayton); Department of Addiction Psychiatry, Oregon Health and Science University, Portland (Dr Fellers); Psychosomatic Medicine, Virginia Commonwealth University Health System, West Hospital, Richmond (Dr Raisinghani); Child Psychiatry, University of Connecticut, West Hartford (Dr Martinez); and Public Health Sciences, The National Social Norms Institute at the University of Virginia, Charlottesville (Dr Keller).
authors.forename: Elle M
authors.initials: EM
authors.lastname: Sowa
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville (Drs Sowa, Santa Cruz, Hidalgo, Lee, and Clayton); Department of Addiction Psychiatry, Oregon Health and Science University, Portland (Dr Fellers); Psychosomatic Medicine, Virginia Commonwealth University Health System, West Hospital, Richmond (Dr Raisinghani); Child Psychiatry, University of Connecticut, West Hartford (Dr Martinez); and Public Health Sciences, The National Social Norms Institute at the University of Virginia, Charlottesville (Dr Keller).
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Fellers
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville (Drs Sowa, Santa Cruz, Hidalgo, Lee, and Clayton); Department of Addiction Psychiatry, Oregon Health and Science University, Portland (Dr Fellers); Psychosomatic Medicine, Virginia Commonwealth University Health System, West Hospital, Richmond (Dr Raisinghani); Child Psychiatry, University of Connecticut, West Hartford (Dr Martinez); and Public Health Sciences, The National Social Norms Institute at the University of Virginia, Charlottesville (Dr Keller).
authors.forename: Rachna S
authors.initials: RS
authors.lastname: Raisinghani
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville (Drs Sowa, Santa Cruz, Hidalgo, Lee, and Clayton); Department of Addiction Psychiatry, Oregon Health and Science University, Portland (Dr Fellers); Psychosomatic Medicine, Virginia Commonwealth University Health System, West Hospital, Richmond (Dr Raisinghani); Child Psychiatry, University of Connecticut, West Hartford (Dr Martinez); and Public Health Sciences, The National Social Norms Institute at the University of Virginia, Charlottesville (Dr Keller).
authors.forename: Maria R
authors.initials: MR
authors.lastname: Santa Cruz
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville (Drs Sowa, Santa Cruz, Hidalgo, Lee, and Clayton); Department of Addiction Psychiatry, Oregon Health and Science University, Portland (Dr Fellers); Psychosomatic Medicine, Virginia Commonwealth University Health System, West Hospital, Richmond (Dr Raisinghani); Child Psychiatry, University of Connecticut, West Hartford (Dr Martinez); and Public Health Sciences, The National Social Norms Institute at the University of Virginia, Charlottesville (Dr Keller).
authors.forename: Priscilla C
authors.initials: PC
authors.lastname: Hidalgo
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville (Drs Sowa, Santa Cruz, Hidalgo, Lee, and Clayton); Department of Addiction Psychiatry, Oregon Health and Science University, Portland (Dr Fellers); Psychosomatic Medicine, Virginia Commonwealth University Health System, West Hospital, Richmond (Dr Raisinghani); Child Psychiatry, University of Connecticut, West Hartford (Dr Martinez); and Public Health Sciences, The National Social Norms Institute at the University of Virginia, Charlottesville (Dr Keller).
authors.forename: Meredith S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville (Drs Sowa, Santa Cruz, Hidalgo, Lee, and Clayton); Department of Addiction Psychiatry, Oregon Health and Science University, Portland (Dr Fellers); Psychosomatic Medicine, Virginia Commonwealth University Health System, West Hospital, Richmond (Dr Raisinghani); Child Psychiatry, University of Connecticut, West Hartford (Dr Martinez); and Public Health Sciences, The National Social Norms Institute at the University of Virginia, Charlottesville (Dr Keller).
authors.forename: Lady A
authors.initials: LA
authors.lastname: Martinez
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville (Drs Sowa, Santa Cruz, Hidalgo, Lee, and Clayton); Department of Addiction Psychiatry, Oregon Health and Science University, Portland (Dr Fellers); Psychosomatic Medicine, Virginia Commonwealth University Health System, West Hospital, Richmond (Dr Raisinghani); Child Psychiatry, University of Connecticut, West Hartford (Dr Martinez); and Public Health Sciences, The National Social Norms Institute at the University of Virginia, Charlottesville (Dr Keller).
authors.forename: Adrienne E
authors.initials: AE
authors.lastname: Keller
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville (Drs Sowa, Santa Cruz, Hidalgo, Lee, and Clayton); Department of Addiction Psychiatry, Oregon Health and Science University, Portland (Dr Fellers); Psychosomatic Medicine, Virginia Commonwealth University Health System, West Hospital, Richmond (Dr Raisinghani); Child Psychiatry, University of Connecticut, West Hartford (Dr Martinez); and Public Health Sciences, The National Social Norms Institute at the University of Virginia, Charlottesville (Dr Keller).
authors.forename: Anita H
authors.initials: AH
authors.lastname: Clayton