title: Prevalence and Factors Associated with Multiple Provider Episodes in Texas: An Epidemiological Analysis of Prescription Drug Monitoring Program Data.
abstract: OBJECTIVE
  Prescription drug abuse has reached epidemic levels, leading to overdose-related morbidity and mortality. Patient and regional-level factors are believed to contribute to higher rates of prescription drug abuse. The objective of this study was to determine the prevalence and factors associated with multiple provider episodes (MPEs) in Texas.
  
  
  METHODS
  This was a retrospective cohort analysis of data from the Texas Prescription Drug Monitoring Program (PDMP) database, linked with Texas county census data. Descriptive statistics and a multilevel model regression analysis were employed to estimate the prevalence of MPEs and examine the association between individual controlled substance prescription (CSP) utilization and county factors associated with MPEs.
  
  
  RESULTS
  Among the 10,381,532 Texas residents utilizing CSPs in 2013, prescription opioids were the most frequently dispensed CSP (38.64%). The prevalence of MPEs was 71.30 per population of 100,000. Of those with MPEs, 76.98% received CSPs for more than 150 days and 11.48% had an average daily morphine equivalent dose (MED) 100 mg/day or higher. Residing in metropolitan areas, traveling more than 100 miles to obtain and fill prescriptions, chronic use of CSPs, younger age, and high MED were all significantly associated with increased risk of MPEs.
  
  
  CONCLUSIONS
  This study revealed that previous estimates of prescription drug abuse may be drastically underestimated. Prescription drug abuse is a major public health problem in Texas, especially in metropolitan areas. Therefore, prevention efforts need to be addressed at the individual level and through public health and policy legislation.
authors.affiliation: University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Ferries
authors.affiliation: Pain & Policy Studies Group, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, World Health Organization Collaborating Center on Pain Policy and Palliative Care, Madison, Wisconsin, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Gilson
authors.affiliation: University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas.
authors.forename: Rajendar R
authors.initials: RR
authors.lastname: Aparasu
authors.affiliation: University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas.
authors.forename: Hua
authors.initials: H
authors.lastname: Chen
authors.affiliation: University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Johnson
authors.affiliation: University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Fleming
mesh_terms: D015331:Cohort Studies; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D000073958:Prescription Drug Monitoring Programs; D015995:Prevalence; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013781:Texas / Q000453:epidemiology
keywords: Controlled Substance Prescriptions (CSPs); Multiple Provider Episodes (MPE); Prescription Drug Abuse; Prescription Drug Monitoring Program (PDMP); Prescription Opioids