Balancing diversion control and medical necessity: the case of prescription drugs with abuse potential.

Narcotics and other prescription drugs play a significant and legitimate role in medical practice. The illicit use of prescribed medicines, however, remains a major problem. This paper examines the effectiveness of two drug diversion control programs, multiple copy prescriptions programs (MCPP) and electronic data transfer (EDT) systems, and their impact on medical practice. Current evidence demonstrates that these programs decrease prescription drug use, with much of the decrease due to declines in inappropriate use. MCPPs appear more effective than EDT in preventing diversion. More research is needed. however, to assess their effects on medical practice, particularly patient quality of care.

The use of abusable prescription drugs: the role of gender.

It is well documented that women face greater medical exposure to psychotropic drugs than do men, but little research examines whether women also have increased use of prescription drugs with abuse potential. The objectives were to examine gender differences in the use of abusable prescription drugs and to assess how use varies by gender and if patterns of use vary across therapeutic drug classes. With data from the 1987 National Medical Expenditures Survey (NMES), logistic regression analysis is used to model the influence of gender and other sociodemographic and diagnostic variables on the probability of drug use. Women are 48% more likely than men to use any abusable prescription drug, controlling for demographics, health status, economic status, and diagnosis. Additional analyses reveal that being female is a statistically significant predictor of anxiolytic and narcotic analgesic use but not of sedative-hypnotic or stimulant use. Marital status, age, urbanicity, employment status, and having a regular source of care explain gender differences in the use of abusable prescription drugs. Both healthcare and substance abuse treatment providers should be cognizant that women may have greater exposure to these potent prescription medicines.

Differences in prescription drug utilization and expenditures between Blacks and Whites in the Georgia Medicaid population.

To address policy concerns regarding prescription drug access by vulnerable minority groups, we analyzed prescription drug use and spending among black and white enrollees in the Georgia Medicaid program. Using a two-part model estimating use and level of use of any prescription drugs, the study examined black/white differences controlling for age, sex, and Medicaid eligibility characteristics. Results showed black enrollees were significantly less likely to use any prescription drugs and received significantly fewer prescriptions than white enrollees. After adjustment, the black/white difference for children was 43%, with black children using 2.7 fewer prescriptions relative to white children. Patterns of use were similar for adults and the elderly, with black adults using 4.9 fewer prescriptions, and black elders using 6.3 fewer prescriptions, than their white peers. Spending rates per full-year enrollee were similar to utilization patterns and maintained the black/white differential. White Medicaid enrollees had higher use and spending than black enrollees across most high-volume therapeutic drug categories. The study explores several possible explanations for these differences.

Gender and psychotropic drug use.

OBJECTIVES: Although studies have documented women's greater use of prescribed psychotropic drugs, few have explicitly examined how women and men differ in psychotropic drug use. This study examines gender differences in aggregate psychotropic drug use, as well as use of specific therapeutic categories, and explores how other factors explaining psychotropic drug use vary by gender. METHODS: Using 1989 National Ambulatory Medical Care Survey (NAMCS) data, logistic regression analysis is used to estimate the probability of psychotropic drug use in aggregate and for four therapeutic categories--anxiolytics, sedative-hypnotics, antidepressants, and antipsychotics. For equations where gender is statistically significant, separate logistic regression equations are estimated to determine the explanatory variables that vary by gender. RESULTS: The probability of receiving any psychotropic drug is 55% greater in office visits by women than those by men, all else constant. Further, gender is a positive and significant predictor of anxiolytic and antidepressant use. Variables estimating anxiolytic and antidepressant use that differ by gender include diagnosis, physician specialty, and payment source for the office visit. CONCLUSIONS: Findings confirm research that has demonstrated that women are more likely than men to receive any psychotropic drug in office-based care. This gender differential holds only for anxiolytics and antidepressants. In addition, there were significant differences in the predictors of drug use for women and men.