Research Article Disclosure of Use and Abuse of Controlled Substances Among Psychiatric Outpatients Background: Prescription drug abuse is a serious health concern and is considered a nationwide epidemic. Patients often fail or refuse to disclose the use of controlled sub- stances, leaving prescribers and pharmacies unaware of the potential for harmful drug interactions and risk of overdose. Psychiatric patients are especially vulnerable to con- trolled substance misuse. Objectives: To determine hazardous patterns of prescription drug use among psychiatric outpatients and to raise awareness about the importance of reviewing information pro- vided by prescription drug monitoring pro- grams (PDMPs). Methods: The medical records of 150 patients attending the Adult Outpatient Psychiatric Clinic at the Los Angeles County+University of Southern California (LAC+USC) Medical Center from July 2012 through May 2013 were reviewed. Patient activity reports were gen- erated from California’s PDMP. Nondisclosure of controlled substance use was identified by a discrepancy between patient reporting of prescriptions according to the medical records and PDMP reports. A “pattern sug- gestive of prescription drug abuse” was defined as having one or more of the following: within-class prescriptions from multiple pro- viders and/or within-class early refills or within-class overlapping prescriptions picked up within 10 days of each other. Results: Of the 150 patients, 113 were found in California’s PDMP database. Of these 113 patients, 81 had obtained 111 prescriptions for controlled substances in the past 12 months. Of these 111 prescriptions, 52 (47%) were not disclosed to the primary psychiatrist, of which 14 (27%) revealed patterns consistent with prescription drug abuse. Conclusions: Reviewing PDMP databases before prescribing controlled substances should be considered a standard prescribing practice to prevent abuse, diversion, and adverse medical outcomes. (Journal of Psychiatric Practice 2015;21;412– 418) KEY WORDS: prescription drug monitoring pro- grams, California, psychiatric outpatients, prescrip- tion drug abuse, patient nondisclosure, opioid analgesics, central nervous system (CNS) stimu- lants, hypnotics, sedatives In the United States, patients obtain health care services from multiple providers in a variety of settings including, but not limited to, outpatient clinics, urgent care clinics, and emergency depart- ments. This fragmentation of care may increase the potential for misuse, abuse, and diversion of pre- scribed controlled substances. Some of the abuse patterns associated with prescription drugs include doctor shopping, pharmacy shopping, drug theft, feigning pain symptoms to gain health care access, and drug sharing. 1–3 The problem of abuse of pre- scription opioid analgesics is a well-documented public health concern in the United States. 4,5 A ret- rospective review of insurance claims among Medi- care beneficiaries in 2010 revealed that as many as 60% of patients were having opioid prescriptions written by more than 1 provider, with 12% receiving prescriptions from 4 or more providers. 6 Doctor and pharmacy shopping for controlled substances has been shown to be significantly associated with PATRICIA DE MARCO CENTENO, MD MIRZA BAIG, MD SUNG-EUN MELANIE LEE, PhD CHRISTIANNE J. LANE, PhD ISABEL T. LAGOMASINO, MD, MSHS DE MARCO CENTENO, BAIG, and LAGOMASINO: Depart- ment of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA; LEE: Keck School of Medicine, University of Southern California, Los Angeles, CA; LANE: Department of Preventive Medicine, Division of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. The authors declare no conflicts of interest. Please send correspondence to: Patricia De Marco Centeno, MD, 6385 Dogwood Dr., Huntington Beach, CA 92648 (e-mail: demarco_patricia@yahoo.com). DOI: 10.1097/PRA.0000000000000104 412 November 2015 Journal of Psychiatric Practice Vol. 21, No. 6 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.