Abstract
The opioid maintenance treatments (OMT) are widely misused and diverted in many countries. Doctor shopping represented the main way to obtain high quantities of opioids in abuse/diversion. The aim of this study was to assess the trends in the prevalence of doctor shopping for high dosage buprenorphine (HDB) and methadone (MTD) from 2004to 2014by using the French Health Insurance claims. This was a cross-sectional study of patients treated by OMT (High Dosage Buprenorphine or Methadone) between 2004and 2014from a representative sample of the French Health Insurance claims. Doctor shopping was defined as at least 1day of overlapping prescriptions, written by at least 2different prescribers and filled in at least 3different pharmacies. HDB patients were more likely men (77.9% in 2014) with a mean age ranged from 33.4±7.6years in 2004to 39.5±9.3years in 2014, P<0.001. MTD patients were also more likely men (73.9% in 2014) with a mean age ranged from 33.5±6.9years in 2004to 37.1±8.5years in 2014, P<0.001. In 2014, 35% of HDB patients and 36% of MTD patients presented a long-term disease which was most frequently a mental health disorders. The prevalence of doctor shopping for HDB decreased from 2004to 2014 (12.6% versus 3.9%, P<0.001). The prevalence of doctor shopping for MTD was very low during the period study (0.2% to 0.5%). Overall, the prevalence of doctor shopping was higher for HDB than for MTD whatever the year (P<0.001) of the study. Doctor shopping for HDB decreased significantly during the last decade while doctor shopping for MTD remained nearly inexistent even if it could be underestimated because of dispensations in specialized centers and in hospitals not comprised in the insurance claims. The low rates of doctor shopping reported in these last years could result from the guidelines for good practices in OMT use made in 2004and the adjustments of ANSM (French National Agency for Medicines and Health Products Safety) for HDB best use made in 2011.
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