title: Prescription drug monitoring program inquiry in psychiatric assessment: detection of high rates of opioid prescribing to a dual diagnosis population.
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.
  
  
  METHODS
  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.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Hackman
authors.forename: Marion S
authors.initials: MS
authors.lastname: Greene
authors.forename: Taya J
authors.initials: TJ
authors.lastname: Fernandes
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Brown
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wright
authors.affiliation: IU School of Medicine, Laboratory for Translational Neuroscience of Dual Diagnosis & Development and Addiction Psychiatry Training Program, IU Neuroscience Center, Ste 314, 320 W 15th St, Indianapolis, IN 46202 robchamb@iupui.edu.
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Chambers
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D061891:Controlled Substances; D017831:Diagnosis, Dual (Psychiatry); D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000517:prevention & control*; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D061891:Controlled Substances
references.citation: Pain Med. 2008 Jul-Aug;9(5):587-94
references.pmid: 18565002
references.citation: J Safety Res. 2012 Sep;43(4):283-9
references.pmid: 23127678
references.citation: Biol Psychiatry. 2001 Jul 15;50(2):71-83
references.pmid: 11526998
references.citation: Psychiatr Serv. 2010 Feb;61(2):184-8
references.pmid: 20123825
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Nov 4;60(43):1487-92
references.pmid: 22048730
references.citation: Lancet. 2004 Jul 31-Aug 6;364(9432):453-61
references.pmid: 15288745
references.citation: Pain Med. 2012 Jul;13(7):908-14
references.pmid: 22681237
references.citation: Pain. 2010 Dec;151(3):567-568
references.pmid: 20826051
references.citation: Am J Psychiatry. 2005 Oct;162(10):1911-8
references.pmid: 16199838
references.citation: J Subst Abuse. 1996;8(2):195-210
references.pmid: 8880660
references.citation: Biol Psychiatry. 2004 Nov 15;56(10):730-7
references.pmid: 15556117
references.citation: Drug Alcohol Depend. 2013 Jun 1;130(1-3):1-12
references.pmid: 23279925
references.citation: Clin J Pain. 2010 Jan;26(1):1-8
references.pmid: 20026946
references.citation: J Stud Alcohol. 1997 Sep;58(5):464-73
references.pmid: 9273910
references.citation: J Adolesc Health. 2012 Jun;50(6):553-8
references.pmid: 22626480
references.citation: Pain Physician. 2012 Jul;15(3 Suppl):ES9-38
references.pmid: 22786464
references.citation: Addiction. 2010 Oct;105(10):1776-82
references.pmid: 20712819
references.citation: Pain Med. 2007 Mar;8(2):171-83
references.pmid: 17305688
references.citation: Arch Intern Med. 2006 Oct 23;166(19):2087-93
references.pmid: 17060538
references.citation: JAMA. 2000 Nov 22-29;284(20):2606-10
references.pmid: 11086367
references.citation: Pain Med. 2009 Apr;10(3):537-48
references.pmid: 19416440
references.citation: Arch Gen Psychiatry. 2004 Nov;61(11):1107-15
references.pmid: 15520358
references.citation: Am J Psychiatry. 2001 Feb;158(2):295-302
references.pmid: 11156814
references.citation: J Clin Psychiatry. 2011 May;72(5):589-92
references.pmid: 21536000
references.citation: J Dual Diagn. 2013;9(3):
references.pmid: 24223531
references.citation: Arch Gen Psychiatry. 1994 Jan;51(1):8-19
references.pmid: 8279933
references.citation: MMWR Morb Mortal Wkly Rep. 2010 Jun 18;59(23):705-9
references.pmid: 20559200
references.citation: Ann Emerg Med. 2010 Jul;56(1):19-23.e1-3
references.pmid: 20045578
references.citation: Am J Psychiatry. 2012 Jan;169(1):64-70
references.pmid: 21955932
references.citation: JAMA. 2012 Mar 7;307(9):940-7
references.pmid: 22396516
references.citation: Drug Alcohol Depend. 2012 Sep 1;125(1-2):8-18
references.pmid: 22857878
references.citation: Pain Physician. 2007 May;10(3):479-91
references.pmid: 17525783
references.citation: Drug Alcohol Depend. 2010 Nov 1;112(1-2):90-8
references.pmid: 20634006
references.citation: J Am Board Fam Med. 2011 Nov-Dec;24(6):717-27
references.pmid: 22086815
references.citation: MMWR Morb Mortal Wkly Rep. 2009 Oct 30;58(42):1171-5
references.pmid: 19875978
references.citation: Pain Med. 2009 Apr;10(3):531-6
references.pmid: 19425211
references.citation: Pain Med. 2009 Jul-Aug;10(5):858-65
references.pmid: 19523029
references.citation: Pharmacoepidemiol Drug Saf. 2010 Feb;19(2):115-23
references.pmid: 20014166
references.citation: MMWR Morb Mortal Wkly Rep. 2012 Jan 13;61(1):10-3
references.pmid: 22237030