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Characteristics and Red Flag Correlates of Psychiatric Outpatients in a Mandated-Use Prescription Drug Monitoring Program State

A PBRN Card Study

Hunt, Andrew W., MD, MHA*,†; Clegg, Kathleen, MD*,†; Delos Reyes, Christina M., MD*,†; Riley-Behringer, Maureen, PhD, MSSA*,†,‡; Zyzanski, Stephen, PhD*,†; Werner, James J., PhD, MSSA*,§,∥

Addictive Disorders & Their Treatment: March 2019 - Volume 18 - Issue 1 - p 36–43
doi: 10.1097/ADT.0000000000000147
Original Articles

Objectives: All 50 states have implemented a Prescription Drug Monitoring Program (PDMP) in efforts to control prescription drug abuse. Many now mandate PDMP checks before clinicians prescribe controlled substances. The aim of this study was to characterize the associations between patient characteristics, red flags found on PDMP reports, and prescriber behavior at community mental health agencies.

Methods: Prescribers at 9 practice sites, in 5 regional community mental health centers, were recruited by a practice-based research network to participate in a card study. Prescribers completed a PDMP attitudes survey, and cards were completed for patients who had PDMP reports checked. Data were analyzed using descriptive and inferential statistics.

Results: In total, 39 providers completed cards for n=249 unique patient encounters. Over one third of all patients reported an addiction disorder (38%) or a diagnosis of chronic pain (34%). In total, 20% of PDMP reports were found to have red flags, most commonly multiple prescribers or multiple pharmacies. Red flags were associated with race (P<0.05), presence of chronic pain (P<0.01), presence of an addiction diagnosis (P<0.05), use of opioids (P<0.001), and nonadherence with treatment (P<0.006). Among prescribers, red flags were associated with lower prescribing rates (P<0.01), and decisions to decrease dosage (P<0.002).

Conclusions: Red flags were commonly found on PDMP reports conducted in community mental health settings, and were associated with important patient characteristics and diagnostic factors. Practice-based research network methods can be leveraged to obtain real-time observational data about psychiatric prescribers’ use of PDMP reports in clinical decision-making in different settings.

*Department of Psychiatry, University Hospitals Cleveland Medical Center

Department of Family Medicine, Case Western Reserve University School of Medicine

§Department of Family Medicine & Community Health CWRU Mandel School of Applied Social Sciences

Department of Psychiatry, Mandel School of Applied Social Sciences, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH

Elizabethtown College, Elizabethtown, PA

Supported by Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH Roadmap for Medical Research.

Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

The authors declare no conflict of interest.

Reprints: Andrew W. Hunt, MD, MHA, Department of Psychiatry, University Hospitals, W.O. Walker Building, 7th Floor, 10524 Euclid Avenue, Cleveland, OH 44106 (e-mail:

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