Screening tools may help identify patients at risk for psychotherapeutic medication misuse
Misuse of prescription psychotherapeutic medication was common among primary care patients in urban clinics, but two screening instruments showed promise for identifying those at risk, according to a study published in the Journal of the American Board of Family Medicine.
“In addition to prescription opioid misuse, misuse of tranquilizers (defined as benzodiazepines and muscle relaxants), stimulants (such as amphetamines), and sedatives is growing, albeit largely unrecognized,” Sebastian T. Tong, MD, MPH, of the Virginia Commonwealth University, and colleagues wrote. “Although it is well known that tranquilizers, stimulants and sedatives can have substantial negative effects that include fatal overdose in some cases, they have not been well-studied to date.”
To describe the prevalence of misuse in primary care and the characteristics of patients who misuse — and to compare two screening instruments that may aid in identification of said patients — researchers conducted a cross-sectional survey of 2,339 patients in underserved, urban primary care clinics (mean age, 46.13 years; 70.5% black; 61.7% women; 44.2% unemployed).
Patients responded to four questions related to prescription drug misuse in the past month and research assistants then screened patients with two drug misuse screening instruments. The first questionnaire, entitled Cut down, Annoyed, Guilty, and Eye-opener (RxCAGE), was a modified version of CAGE, an alcohol use disorder screener. The second was the Prescription Opioid Misuse Index (POMI-e), which researchers expanded from a focus on opioid misuse to include all prescription drugs.
Researchers found that, on the RxCAGE, 37.8% of all participants answered “yes” to at least one item and 15.3% answered “yes” to two or more items. The most common affirmative response was related to “feeling the need to cut down” on the use of prescription drugs (22.6%), with the second most common related to using prescription drugs to “get going or to calm down” (21.2%).
On POMI-e, 36.2% of participants answered “yes” to at least one item and 18.6% answered “yes” to two or more. The most common positive response in POMI-e was related to “feeling high or getting a buzz after using medication” (16.7%), with the second most common being “using medication more frequently than prescribed” (15.7%).
When researchers compared RxCAGE and POMI-e, they found that POMI-e with a cutoff score of two or higher had a higher area under the curve (0.63; P < .001).
Finally, researchers wrote that a positive POMI-e was associated with being male, white and unemployed, having depression and anxiety, and currently using illicit substances, smoking and misusing alcohol.
“Given the high association of prescription drug misuse with mental health and substance use comorbidities, patients identified with prescription drug misuse might merit special attention in primary care,” the researchers wrote. “Developing and implementing validated screening tools for prescription psychotherapeutic medication misuse may help primary care clinicians identify and care for patients with prescription drug misuse and reduce the morbidity, societal impacts, and costs of the current prescription drug misuse epidemic.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.