title: Who is prescribing controlled medications to patients who die of prescription drug abuse?
abstract: BACKGROUND
  Prescription drug-related fatalities remain a significant issue in the United States, yet there is a relative lack of knowledge on the specialty-specific prescription patterns for drug-related deaths.
  
  
  METHODS
  We designed a study that investigated medical examiner reports of prescription drug-related deaths that occurred in San Diego County during 2013. A Prescription Drug Monitoring Program search was performed on each of these cases to ascertain which physician specialties had prescribed controlled substances to these patients. The data were analyzed for each specialty, including pills per prescription, type of prescription, doctor shoppers (4 physicians + 4 pharmacies over 1 year), and chronic users (≥3 consecutive months of medications).
  
  
  RESULTS
  In 2013, 4.5% of all providers in San Diego County wrote a prescription for a patient who died a prescription-related death. There were a total of 713 providers who prescribed 4366 medications totaling 328928 pills. Overall, emergency physicians gave the lowest number of prescriptions per provider (1.6), whereas pain management provided the highest amount per provider (12.9). Most prescriptions went to doctor shoppers (>50%) and chronic users (95.8%). Hydrocodone was the most frequently prescribed medication to those patients whose deaths were related to prescription drugs.
  
  
  CONCLUSIONS
  Emergency physicians appear to provide fewer prescriptions to those patients who die due to prescription drugs. Emergency physicians do, however, account for a significant proportion of total providers in this study. These results highlight the need to use Prescription Drug Monitoring Program data to closely monitor prescription patterns and to intervene when necessary.
authors.affiliation: Department of Emergency Medicine, Scripps Mercy Hospital, San Diego, CA 92103.
authors.forename: Roneet
authors.initials: R
authors.lastname: Lev
authors.affiliation: University of Arizona, Tucson, AZ 85721.
authors.forename: Oren
authors.initials: O
authors.lastname: Lee
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA 90033.
authors.forename: Sean
authors.initials: S
authors.lastname: Petro
authors.affiliation: San Diego County Medical Examiners Office, San Diego, CA 92123.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lucas
authors.affiliation: University of California San Diego, Department of Emergency Medicine, San Diego, CA 92103.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Castillo
authors.affiliation: University of California San Diego, Department of Emergency Medicine, San Diego, CA 92103.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.affiliation: University of California San Diego, Department of Emergency Medicine, San Diego, CA 92103. Electronic address: cjcoyne@ucsd.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Coyne
mesh_terms: D000701:Analgesics, Opioid; D002140:California / Q000453:epidemiology; D004636:Emergency Service, Hospital; D006801:Humans; D008511:Medicine; D009293:Opioid-Related Disorders / Q000401:mortality*; D010818:Practice Patterns, Physicians'; D063487:Prescription Drug Misuse / Q000401:mortality* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000701:Analgesics, Opioid