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. 2012 Nov;13(11):1436-43.
doi: 10.1111/j.1526-4637.2012.01497.x. Epub 2012 Oct 11.

Aberrant drug-related behaviors: unsystematic documentation does not identify prescription drug use disorder

Ellen C Meltzer  1 , Dennis Rybin, Lidia Z Meshesha, Richard Saitz, Jeffrey H Samet, Sonia L Rubens, Jane M Liebschutz
Affiliations

Aberrant drug-related behaviors: unsystematic documentation does not identify prescription drug use disorder

Ellen C Meltzer et al. Pain Med. 2012 Nov.

Abstract

Objective: No evidence-based methods exist to identify prescription drug use disorder (PDUD) in primary care (PC) patients prescribed controlled substances. Aberrant drug-related behaviors (ADRBs) are suggested as a proxy. Our objective was to determine whether ADRBs documented in electronic medical records (EMRs) of patients prescribed opioids and benzodiazepines could serve as a proxy for identifying PDUD.

Design: A cross-sectional study of PC patients at an urban, academic medical center.

Subjects: Two hundred sixty-four English-speaking patients (ages 18-60) with chronic pain (≥3 months), receiving ≥1 opioid analgesic or benzodiazepine prescription in the past year, were recruited during outpatient PC visits.

Outcome measures: Composite International Diagnostic Interview defined Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of past year PDUD and no disorder. EMRs were reviewed for 15 prespecified ADRBs (e.g., early refill, stolen medications) in the year before and after study entry. Fisher's exact test compared frequencies of each ADRB between participants with and without PDUD.

Results: Sixty-one participants (23%) met DSM-IV PDUD criteria and 203 (77%) had no disorder; 85% had one or more ADRB documented. Few differences in frequencies of individual behaviors were noted between groups, with only "appearing intoxicated or high" documented more frequently among participants with PDUD (N = 10, 16%) vs no disorder (N = 8, 4%), P = 0.002. The only common ADRB, "emergency visit for pain," did not discriminate between those with and without the disorder (82% PDUD vs 78% no disorder, P = 0.6).

Conclusions: EMR documentation of ADRBs is common among PC patients prescribed opioids or benzodiazepines, but unsystematic clinician documentation does not identify PDUDs. Evidence-based approaches are needed.

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Conflict of interest statement

Conflict of Interest

The authors all report no conflicts of interest. R. Saitz is a consultant for Medical Directions Inc. and BMJ Publishing Group

Figures

Figure 1
Figure 1
Figure Cumulative aberrant drug-related behaviors among participants with prescription drug use disorder and no disorder. No results were statistically significant.
See this image and copyright information in PMC

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