title: The use of a prescription drug monitoring program to develop algorithms to identify providers with unusual prescribing practices for controlled substances.
abstract: The misuse, abuse and diversion of controlled substances have reached epidemic proportion in the United States. Contributing to this problem are providers who over-prescribe these substances. Using one state's prescription drug monitoring program, we describe a series of metrics we developed to identify providers manifesting unusual and uncustomary prescribing practices. We then present the results of a preliminary effort to assess the concurrent validity of these algorithms, using death records from the state's vital records database pertaining to providers who wrote prescriptions to patients who then died of a medication or drug overdose within 30 days. Metrics manifesting the strongest concurrent validity with providers identified from these records related to those who co-prescribed benzodiazepines (e.g., valium) and high levels of opioid analgesics (e.g., oxycodone), as well as those who wrote temporally overlapping prescriptions. We conclude with a discussion of a variety of uses to which these metrics may be put, as well as problems and opportunities related to their use.
authors.affiliation: Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA. ringwalt@PIRE.org.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ringwalt
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Schiro
authors.affiliation: Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Shanahan
authors.affiliation: North Carolina Division of Public Health, Raleigh, NC, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Proescholdbell
authors.affiliation: Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: Meder
authors.affiliation: North Carolina Division of Public Health, Raleigh, NC, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Austin
authors.affiliation: North Carolina Division of Public Health, Raleigh, NC, USA.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Sachdeva
mesh_terms: D000465:Algorithms; D000701:Analgesics, Opioid / Q000627:therapeutic use; D061891:Controlled Substances; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000379:methods*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D009657:North Carolina / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid; D061891:Controlled Substances
keywords: Aberrant prescribing; Controlled substances; Opioids; Unusual prescribing