Sarah E. Wixson

Law Enforcement Perceptions of a Prescription Drug Monitoring Programme

In an effort to address the problem of prescription drug abuse and diversion in the USA, States have implemented prescription drug monitoring programmes (PDMPs) to track the prescribing and dispensing of controlled substances. For PDMPs to meet their objectives, law enforcement officials must be able to access the information contained within reports. This study provides a descriptive analysis of opinions held by Kentucky law enforcement officials regarding the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, the States PDMP. Surveys designed to elicit perceptions regarding the effectiveness of KASPER were emailed to all 1,119 Kentucky law enforcement officials with a KASPER account; responses were received from 340 (response rate 30.4 per cent). Of these, 306 responses were included in the analysis. Most (65 per cent) respondents indicated that they had utilised a KASPER report in the month prior to survey participation with a median of three reports utilised (interquartile range (IQR): 2–5). Overall, law enforcement officials perceive KASPER to be an effective tool with which to reduce drug abuse and diversion (92 per cent; n = 280) and doctor shopping (89 per cent; n = 269) in Kentucky. Results indicate that Kentucky law enforcement officials utilise KASPER reports as part of their investigations and view KASPER as an effective tool to reduce drug abuse/diversion and doctor shopping within the State. Further studies exploring the characteristics of law enforcement users of PDMPs and key PDMP features that aid prescription drug diversion and doctor shopping investigations may assist in developing strategies to increase the effectiveness of PDMPs.

Sex differences in benzodiazepine use in the HIV-infected population

In the HIV-infected population there is a high prevalence of psychiatric disorders, conditions that often coexist with drug and alcohol dependence. Symptoms associated with psychiatric disorders are frequently managed with benzodiazepines, a class of medication often abused. We examined whether HIV-infected patients were more likely to fill a benzodiazepine prescription than their uninfected counterparts using a privately insured, nationally representative sample receiving clinical care between January 2007 and December 2009. Odds ratios (OR) and 95% confidence intervals (CI) to quantify the likelihood of receiving a benzodiazepine were calculated using multivariate logistic regression models. We examined the presence of interaction between HIV infection and sex using backwards elimination and by comparing stratum-specific OR to identify clinically meaningful differences. Overall, 323,796 beneficiaries were included in the sample, of which 723 were HIV infected. Bivariate analyses showed that compared to the uninfected sample, HIV-infected patients were more likely to have filled a benzodiazepine prescription (24% vs. 19%) during the study period. HIV-infected patients were also more likely to be male (80% vs. 44%), black (21% vs. 7%) and have a diagnosis of depression (12% vs. 8%) or insomnia (6% vs. 3%) than were uninfected patients. Adjusted for other covariates, HIV infection was associated with an increase (OR): 1.68, 95% CI: 1.39, 2.02) in the likelihood of filling a benzodiazepine prescription. When stratified by sex, HIV-infected males were more likely (OR: 1.68, 95% CI: 1.05, 2.67) than uninfected males to fill a benzodiazepine prescription while there was no observed difference in the likelihood of filling a benzodiazepine prescription between HIV-infected and uninfected females (OR: 1.12, 95% CI: 0.73, 1.70). Our findings suggest that HIV-infected patients, particularly HIV-infected males, are more likely to fill benzodiazepine prescriptions than their uninfected counterparts, highlighting the need for further research to investigate reasons for these observed differences.