Tong Sebastian T, Polak Kathryn M, Weaver Michael F, Villalobos Gabriela C, Smith Wally R, Svikis Dace S
From Virginia Commonwealth University, Richmond, VA (STT, KMP, GCV, WRS, DSS); University of Texas Health Science Center at Houston, TX (MFW)
From Virginia Commonwealth University, Richmond, VA (STT, KMP, GCV, WRS, DSS); University of Texas Health Science Center at Houston, TX (MFW).
J Am Board Fam Med. 2019 Mar-Apr;32(2):272-278. doi: 10.3122/jabfm.2019.02.180172.
Prescription psychotherapeutic medication misuse is a growing problem in the United States, but no method exists to routinely screen for this in primary care. Our study sought to (1) describe the prevalence of prescription psychotherapeutic medication misuse in primary care and the characteristics of patients who misuse and (2) compare 2 screening instruments modified to identify prescription medication misuse in primary care.
Primary care patients from underserved, urban clinics within a health system completed anonymous computer-directed health screens that included standard questions about prescription medication misuse. They were also administered the 4-item Cut down, Annoyed, Guilty, and Eye-opener questionnaire modified to focus on prescription medications (RxCAGE) and a 6-item Prescription Opioid Misuse Index (POMI-e) expanded to include other prescription medications.
Of 2,339 respondents, 15.3% were positive for at least 2 items on the RxCAGE and 18.6% were positive for at least 2 items on the POMI-e. Using our computer-directed health screen as a comparison, we found that POMI-e had a higher area under the curve (0.63). 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.
Rates of prescription medication misuse were substantial with both RxCAGE and POMI-e showing promise as screening instruments. Future studies are needed to test prescription medication misuse screening tools in broader populations and pilot interventions for those screening positive.
在美国，处方心理治疗药物滥用问题日益严重，但在初级保健中尚无常规筛查方法。我们的研究旨在：（1）描述初级保健中处方心理治疗药物滥用的患病率以及滥用患者的特征；（2）比较两种为识别初级保健中处方药物滥用而修改的筛查工具。
来自卫生系统内服务不足的城市诊所的初级保健患者完成了匿名的计算机指导健康筛查，其中包括关于处方药物滥用的标准问题。他们还接受了经修改以关注处方药物的4项减少用量、烦恼、内疚和警醒问卷（RxCAGE）以及扩展到包括其他处方药物的6项处方阿片类药物滥用指数（POMI - e）。
在2339名受访者中，15.3%的人在RxCAGE上至少有2项呈阳性，18.6%的人在POMI - e上至少有2项呈阳性。以我们的计算机指导健康筛查作为对照，我们发现POMI - e的曲线下面积更高（0.63）。POMI - e呈阳性与男性、白人、失业、患有抑郁症和焦虑症、目前使用非法物质、吸烟以及滥用酒精有关。
RxCAGE和POMI - e显示出作为筛查工具的潜力，处方药物滥用率相当高。未来需要开展研究，在更广泛的人群中测试处方药物滥用筛查工具，并针对筛查呈阳性者进行试点干预。
