title: Disclosure of Use and Abuse of Controlled Substances Among Psychiatric Outpatients.
abstract: BACKGROUND
  Prescription drug abuse is a serious health concern and is considered a nationwide epidemic. Patients often fail or refuse to disclose the use of controlled substances, leaving prescribers and pharmacies unaware of the potential for harmful drug interactions and risk of overdose. Psychiatric patients are especially vulnerable to controlled substance misuse.
  
  
  OBJECTIVE
  To determine hazardous patterns of prescription drug use among psychiatric outpatients and to raise awareness about the importance of reviewing information provided by prescription drug monitoring programs (PDMPs).
  
  
  METHODS
  The medical records of 150 patients attending the Adult Outpatient Psychiatric Clinic at the Los Angeles County+University of Southern California (LAC+USC) Medical Center from July 2012 through May 2013 were reviewed. Patient activity reports were generated from California's PDMP. Nondisclosure of controlled substance use was identified by a discrepancy between patient reporting of prescriptions according to the medical records and PDMP reports. A "pattern suggestive of prescription drug abuse" was defined as having one or more of the following: within-class prescriptions from multiple providers and/or within-class early refills or within-class overlapping prescriptions picked up within 10 days of each other.
  
  
  RESULTS
  Of the 150 patients, 113 were found in California's PDMP database. Of these 113 patients, 81 had obtained 111 prescriptions for controlled substances in the past 12 months. Of these 111 prescriptions, 52 (47%) were not disclosed to the primary psychiatrist, of which 14 (27%) revealed patterns consistent with prescription drug abuse.
  
  
  CONCLUSIONS
  Reviewing PDMP databases before prescribing controlled substances should be considered a standard prescribing practice to prevent abuse, diversion, and adverse medical outcomes.
authors.affiliation: DE MARCO CENTENO, BAIG, and LAGOMASINO: Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA LEE: Keck School of Medicine, University of Southern California, Los Angeles, CA LANE: Department of Preventive Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Patricia
authors.initials: P
authors.lastname: De Marco Centeno
authors.forename: Mirza
authors.initials: M
authors.lastname: Baig
authors.forename: Sung-Eun Melanie
authors.initials: SE
authors.lastname: Lee
authors.forename: Christianne J
authors.initials: CJ
authors.lastname: Lane
authors.forename: Isabel T
authors.initials: IT
authors.lastname: Lagomasino
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D061891:Controlled Substances / Q000009:adverse effects; D008192:Deception; D016903:Drug Monitoring / Q000379:methods / Q000706:statistics & numerical data; D004335:Drug and Narcotic Control / Q000379:methods / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008501:Medical Records, Problem-Oriented / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D028642:Persons with Psychiatric Disorders / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D010045:Outpatients; D063487:Prescription Drug Misuse / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000145:classification / Q000494:pharmacology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014342:Truth Disclosure
chemical_list: D061891:Controlled Substances; D055553:Prescription Drugs