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Controlled Substance Prescribing Patterns--Prescription Behavior Surveillance System, Eight States, 2013.

Abstract Drug overdose is the leading cause of injury death in the United States. The death rate from drug overdose in the United States more than doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in 2013. The increase in drug overdoses is attributable primarily to the misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/tranquilizers, and stimulants. Such drugs are prescribed widely in the United States, with substantial variation by state. Certain patients obtain drugs for nonmedical use or resale by obtaining overlapping prescriptions from multiple prescribers. The risk for overdose is directly associated with the use of multiple prescribers and daily dosages of >100 morphine milligram equivalents (MMEs) per day.
PMID
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Authors

Mayor MeshTerms

Controlled Substances

Keywords
Journal Title morbidity and mortality weekly report. surveillance summaries (washington, d.c. : 2002)
Publication Year Start




PMID- 26469747
OWN - NLM
STAT- MEDLINE
DA  - 20151016
DCOM- 20160119
LR  - 20151016
IS  - 1545-8636 (Electronic)
IS  - 0892-3787 (Linking)
VI  - 64
IP  - 9
DP  - 2015 Oct 16
TI  - Controlled Substance Prescribing Patterns--Prescription Behavior Surveillance
      System, Eight States, 2013.
PG  - 1-14
LID - 10.15585/mmwr.ss6409a1 [doi]
AB  - PROBLEM/CONDITION: Drug overdose is the leading cause of injury death in the
      United States. The death rate from drug overdose in the United States more than
      doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in
      2013. The increase in drug overdoses is attributable primarily to the misuse and 
      abuse of prescription drugs, especially opioid analgesics,
      sedatives/tranquilizers, and stimulants. Such drugs are prescribed widely in the 
      United States, with substantial variation by state. Certain patients obtain drugs
      for nonmedical use or resale by obtaining overlapping prescriptions from multiple
      prescribers. The risk for overdose is directly associated with the use of
      multiple prescribers and daily dosages of >100 morphine milligram equivalents
      (MMEs) per day. PERIOD COVERED: 2013. DESCRIPTION OF SYSTEM: The Prescription
      Behavior Surveillance System (PBSS) is a public health surveillance system that
      allows public health authorities to characterize and quantify the use and misuse 
      of prescribed controlled substances. PBSS began collecting data in 2012 and is
      funded by CDC and the Food and Drug Administration. PBSS uses standard metrics to
      measure prescribing rates per 1,000 state residents by demographic variables,
      drug type, daily dose, and source of payment. Data from the system can be used to
      calculate rates of misuse by certain behavioral measures such as use of multiple 
      prescribers and pharmacies within specified time periods. This report is based on
      2013 de-identified data (most recent available) that represent approximately one 
      fourth of the U.S. POPULATION: Data were submitted quarterly by prescription drug
      monitoring programs (PDMPs) in eight states (California, Delaware, Florida,
      Idaho, Louisiana, Maine, Ohio, and West Virginia) that routinely collect data on 
      every prescription for a controlled substance to help law enforcement and health 
      care providers identify misuse or abuse of such drugs. RESULTS: In all eight
      states, opioid analgesics were prescribed approximately twice as often as
      stimulants or benzodiazepines. Prescribing rates by drug class varied widely by
      state: twofold for opioids, fourfold for stimulants, almost twofold for
      benzodiazepines, and eightfold for carisoprodol, a muscle relaxant. Rates for
      opioids and benzodiazepines were substantially higher for females than for males 
      in all states. In most states, opioid prescribing rates peaked in either the
      45-54 years or the 55-64 years age group. Benzodiazepine prescribing rates
      increased with age. Louisiana ranked first in opioid prescribing, and Delaware
      and Maine had relatively high rates of use of long-acting (LA) or
      extended-release (ER) opioids. Delaware and Maine ranked highest in both mean
      daily opioid dosage and in the percentage of opioid prescriptions written for
      >100 MMEs per day. The top 1% of prescribers wrote one in four opioid
      prescriptions in Delaware, compared with one in eight in Maine. For the five
      states whose PDMPs collected the method of payment, the percentage of controlled 
      substance prescriptions paid for in cash varied almost threefold, and the
      percentage paid by Medicaid varied sixfold. In West Virginia, for 1 of every 5
      days of treatment with an opioid, the patient also was taking a benzodiazepine.
      Multiple-provider episode rates were highest in Ohio and lowest in Louisiana.
      INTERPRETATION: This report presents rates of population-based prescribing and
      behavioral measures of drug misuse in the general population that have not been
      available previously for comparison among demographic groups and states. The
      higher prescribing rates for opioids among women compared with men are consistent
      with a higher self-reported prevalence of certain common types of pain, such as
      lower back pain among women. The trend in opioid prescribing rates with age is
      consistent with an increase in the prevalence of chronic pain with age, but the
      increasing prescribing rates of benzodiazepines with age is not consistent with
      the fact that anxiety is most common among persons aged 30-44 years. The
      variation among states in the type of opioid or benzodiazepine of choice is
      unexplained. Most opioid prescribing occurs among a small minority of
      prescribers. Most of the prescriptions by top-decile prescribers probably are
      written by general, family medicine, internal medicine, and midlevel
      practitioners. The source of payment varied by state, for reasons that are
      unclear. Persons who are prescribed opioids also are commonly prescribed
      benzodiazepine sedatives despite the risk for additive depressant effects. PUBLIC
      HEALTH ACTIONS: States can use their prescription drug monitoring programs to
      generate population-based measures for the prescribing of controlled substances
      and for behaviors that suggest their misuse. Comparing data with other states and
      tracking changes in these measures over time can be useful in measuring the
      effect of policies designed to reduce prescription drug misuse.
FAU - Paulozzi, Leonard J
AU  - Paulozzi LJ
AD  - Division of Unintentional Injury Prevention, National Center for Injury
      Prevention and Control, CDC.
FAU - Strickler, Gail K
AU  - Strickler GK
FAU - Kreiner, Peter W
AU  - Kreiner PW
FAU - Koris, Caitlin M
AU  - Koris CM
CN  - Centers for Disease Control and Prevention (CDC)
LA  - eng
PT  - Journal Article
DEP - 20151016
PL  - United States
TA  - MMWR Surveill Summ
JT  - Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. :
      2002)
JID - 101142015
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Central Nervous System Stimulants)
RN  - 0 (Controlled Substances)
RN  - 0 (Prescription Drugs)
RN  - 12794-10-4 (Benzodiazepines)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Analgesics, Opioid/therapeutic use
MH  - Benzodiazepines/therapeutic use
MH  - Central Nervous System Stimulants/therapeutic use
MH  - *Controlled Substances
MH  - Drug Overdose/epidemiology
MH  - Drug Prescriptions/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Population Surveillance/*methods
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Prescription Drug Misuse/adverse effects/statistics & numerical data
MH  - Prescription Drugs/*therapeutic use
MH  - United States/epidemiology
MH  - Young Adult
EDAT- 2015/10/16 06:00
MHDA- 2016/01/20 06:00
CRDT- 2015/10/16 06:00
AID - 10.15585/mmwr.ss6409a1 [doi]
PST - epublish
SO  - MMWR Surveill Summ. 2015 Oct 16;64(9):1-14. doi: 10.15585/mmwr.ss6409a1.

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