OBJECTIVES: The Texas Prescription Monitoring Program (PMP) is an all-payer database that records all controlled substance prescriptions (CSP) dispensed through community pharmacies state-wide. Given the increased national prevalence of prescription stimulant misuse, the PMP provides a useful tool in preventing inappropriate dispensing of these medications. This study aimed to identify: (i) the frequency with which prescription stimulants were queried and (ii) the predictors of querying them.

METHODS: This cross-sectional study of prescription stimulants included patients of all ages who received at least one prescription for any of the following drug ingredients between October 1^st, 2016 and December 31^st, 2018: mixed amphetamine salts, amphetamine, methylphenidate, dextroamphetamine, dexmethylphenidate, or lisdexamfetamine. The medications were identified by compiling a list of national drug codes from the RxNav database. Indicator variables were generated to show whether a prescription had been queried between the date written and fill date, and if so, whether it was queried by a physician, pharmacist, or both. A multiple logistic regression model was used to identify the factors associated with prescription querying.

RESULTS: Of the 12,334,823 prescriptions included for analysis, 544,883 (4.42%) were queried. 2.24%, 2.05%, and 0.13% of the prescriptions were queried by pharmacists, prescribers, and both respectively. Mixed amphetamine salts (AOR: 1.659; CI: 1.634-1.683) and dextroamphetamines (AOR: 1.510; CI: 1.467-1.554) were most likely to be queried compared to methylphenidates. Patients aged 25-34 years old were more likely to have prescriptions queried than those aged 1-14 years old (AOR: 3.102; CI: 3.069-3.135). Patients who paid in cash were almost twice as likely to have their prescription queried compared to those paying via insurance (AOR: 1.727; CI: 1.711-1.744).

CONCLUSIONS: Despite the increased prevalence of stimulant misuse and diversion, healthcare providers in Texas still squander the potential of the PMP by not querying these medications in a consistent manner prior to prescribing or dispensing.