Wilsey BL, Fishman SM, Gilson AM, et al .Profiling multiple provider prescribing of opioids, benzodiazepines, stimulants, and anorectics
VA Northern California Health Care System, Sacramento, CA 95655, USA. Drug and alcohol dependence
(Impact Factor: 3.42).
11/2010; 112(1-2):99-106. DOI: 10.1016/j.drugalcdep.2010.05.007
The main objective of this study was to determine the prevalence of multiple providers for different controlled substances using the largest electronic prescription monitoring program (PMP) in the United States. A secondary objective was to explore patient and medication variables associated with prescriptions involving multiple providers. PMPs monitor the final allocation of controlled substances from pharmacist to patient. The primary purpose of this scrutiny is to diminish the utilization of multiple providers for controlled substances.
This is a secondary data analysis of the California PMP, the Controlled Substance Utilization Review and Evaluation System (CURES). The prevalence of multiple provider episodes was determined using data collected during 2007. A series of binomial logistic regressions was used to predict the odds ratio (OR) of multiple prescriber episodes for each generic type of controlled substance (i.e., opioid, benzodiazepine, stimulant, or diet pill (anorectic) using demographic and prescription variables.
Opioid prescriptions (12.8%) were most frequently involved in multiple provider episodes followed by benzodiazepines (4.2%), stimulants (1.4%), and anorectics (0.9%), respectively. The greatest associations with multiple provider episodes were simultaneously receiving prescriptions for different controlled substances.
Opioids were involved in multiple provider prescribing more frequently than other controlled substances. The likelihood of using multiple providers to obtain one class of medications was substantially elevated as patients received additional categories of controlled substances from the same provider or from multiple practitioners. Polypharmacy represents a signal that requires additional vigilance to detect the potential presence of doctor shopping.
Available from: PubMed Central
- "Doctor-shopping behavior is increasingly recognized for opioids [7–10], but less is known about doctor-shopping behavior for ADHD medications. On the basis of data from California’s Prescription Monitoring Programs, 1.4 % of subjects dispensed ADHD medication had multiple providers in 2007 . However, it is unclear how the behavior should be defined, how many individuals engage in the behavior (incidence), how often it occurs in a given subject or across subjects (frequency), the impact of age and sex on such behavior, or whether a small proportion of subjects are responsible for a large proportion of shopping episodes (concentration). "
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Attention-deficit hyperactivity disorder (ADHD) medications are subject to abuse, misuse, and diversion. Obtaining ADHD prescriptions from multiple prescribers or filled across multiple pharmacies, known as ‘doctor shopping’, may reflect such unsanctioned use. We sought to create a definition of shopping behavior that differentiated ADHD medications from medications with low risk of diversion, i.e. asthma medications, and describe the incidence, frequency, and demography of shopping behavior.
This was a retrospective cohort study in a pharmacy database—LRx—covering 65 % of US retail pharmacies. Subjects had ADHD or asthma medication dispensed between February 2011 and January 2012. We followed subjects for 18 months to assess the number with overlapping dispensings from different prescribers, and the number of prescribers and pharmacies involved in those dispensings.
We included 4,402,464 subjects who were dispensed ADHD medications, and 6,128,025 subjects who were dispensed asthma medications. Overlapping prescriptions from two or more prescribers dispensed by three or more pharmacies was four times more frequent in the ADHD cohort than in the asthma cohort. Using this definition, ADHD medication shopping behavior was more common among experienced users than naïve users, and was most common in subjects aged 10–39 years. Among subjects who shopped, 57.4 % shopped only once (accounting for 22.4 % of episodes), and 9.2 % shopped six or more times (accounting for 42.0 % of episodes). Shoppers more often received stimulant ADHD drugs than non-stimulants.
Overlapping prescriptions by different prescribers and filled at three or more pharmacies defines ADHD medication shopping. Shopping behavior is most common in adolescents and younger adults. A small proportion of shoppers is responsible for a large number of shopping episodes.
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ABSTRACT: Drugs affecting the central nervous system form a unique group of products for surveillance because they could be misused, abused or diverted. Considering the characteristics of this behaviour that is often concealed, specific post-marketing surveillance systems have been developed to monitor abuse of prescription drugs in some countries. The purpose of this review is to list and to describe post-marketing surveillance systems, according their methodology, in France and in foreign countries. These programs are based on adverse effect notifications, medical or legal consequences of abuse, general or specific population-based survey, professional networks or medication databases. Some programs use simultaneously several information sources. In conclusion, the multifaceted nature, the diversity and the inventiveness of post-marketing surveillance systems reflects the complexity of the abuse issue.
Available from: Kim Aaron
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ABSTRACT: About a year ago, NASA Headquarters requested the SIM project to develop a less costly approach to performing micro-arc-second astrometry. The SIM Team responded by forming a Tiger Team and attacking the problem with vigor. Eliminating two secondary objectives (ing and imaging) opened up several options that led to a new configuration that met the cost target. Another simplification came about when it was decided to launch using the Space Shuttle. The very large payload bay allowed us to eliminate the hinge in the middle of the precision structure supporting the optical elements. In this paper, we discuss the current reference design of the SIM instrument, and illustrate some of the tradeoffs that led to this arrangement.
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