Meanwhile, a study of 2848 US adults published in the January issue of the Annals of Internal Medicine revealed that 91% of patients continued to receive prescription opioids even after they had overdosed on them.4

Another contributing factor, say Drs Mandl and Ong, is the increase in medical specialization and multi-disciplinary patient care, which can lead to problems with care coordination such as medication prescribing from multiple providers.


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“Patients with mental health disorders are much more susceptible to both prescription drug overdoses and multiple provider prescribing of controlled substances,” they told Psychiatry Advisor. Such a practice can be the result of uncoordinated care or patient “doctor shopping” by a substance-abusing patient.  

In a study published last month  in the Journal of General Internal Medicine, Drs Mandl and Ong, joined by other colleagues, used multi-year data from healthcare claims to examine the effects of provider patient-sharing and collaboration on rates of multiple benzodiazepine prescribing.5 Of 5659 patients aged 18 to 64 years who were prescribed two or more overlapping benzodiazepines, 18% had received them from more than one provider.

Patients of providers who more often shared patients and collaborated with other providers had a lower risk of receiving overlapping prescriptions compared to those whose providers rarely shared patients. “So, we believe it is likely a major contributor to prescription drug overdose that is currently under-recognised,” the researchers wrote.

An additional factor influencing the epidemic is the “ease of obtaining controlled substances through ‘legal’ means–there is a strong tie between heroin dependence and opioid-related overdoses, as people tend to use these drugs interchangeably,” they added.

Abeed Sarker, a post-doctoral research scholar at Arizona State University at the Mayo Clinic, noted that “among college students, the use of performance enhancement medications such as Adderall is very popular and increasing over time,” especially during specific times of the year such as exams. Those are some of the observations he and colleagues made in their research into the use of social media to discern patterns of drug abuse from users’ posts.2