Early Detection of Prescription Drug Abuse Using Doctor Shopping Monitoring From Claims Databases: Illustration From the Experience of the French Addictovigilance Network.

Thomas Soeiro,Maryse Lapeyre-Mestre,Joëlle Micallef,Vincent Pradel,Clémence Lacroix

doi:10.3389/fpsyt.2021.640120

Abstract

Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence. Awareness of prescription drug abuse has been increasing in the last two decades, and organizations such as the International Narcotics Control Board has predicted that, worldwide, prescription drug abuse may exceed the use of illicit drugs. Assessment of prescription drug abuse tackles an issue that is hidden by nature, which therefore requires a specific monitoring. The current best practice is to use multiple detection systems to assess prescription drug abuse by various populations in a timely, sensitive, and specific manner. In the early 2000's, we designed a method to detect and quantify doctor shopping for prescription drugs from the French National Health Data System, which is one of the world's largest claims database, and a first-class data source for pharmacoepidemiological studies. Doctor shopping is a well-known behavior that involves overlapping prescriptions from multiple prescribers for the same drug, to obtain higher doses than those prescribed by each prescriber on an individual basis. In addition, doctor shopping may play an important role in supplying the black market. The paper aims to review how doctor shopping monitoring can improve the early detection of prescription drug abuse within a multidimensional monitoring. The paper provides an in-depth overview of two decades of development and validation of the method as a complementary component of the multidimensional monitoring conducted by the French Addictovigilance Network. The process accounted for the relevant determinants of prescription drug abuse, such as pharmacological data (e.g., formulations and doses), chronological and geographical data (e.g., impact of measures and comparison between regions), and epidemiological and outcome data (e.g., profiles of patients and trajectories of care) for several pharmacological classes (e.g., opioids, benzodiazepines, antidepressants, and methylphenidate).

Highlights

Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence [1]
The paper aims to review how doctor shopping monitoring can improve the early detection of prescription drug abuse within a multidimensional monitoring
The paper provides an in-depth overview of two decades of development and validation of the method as a complementary component of the multidimensional monitoring conducted by the French Addictovigilance Network

Summary

INTRODUCTION

Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence [1]. By using various tools to mine epidemiological data, assess the pharmacological properties of the drugs, and assess the social contexts where the drugs are used, these systems demonstrated their usefulness to detect emerging trends earlier and intervene more quickly to protect the public from associated risks [12] Among these tools, assessing doctor shopping through overlapping prescriptions, multiple prescribers, or pharmacy shopping was implemented in several countries [13,14,15,16,17,18,19]. Most studies assessing doctor shopping rely on the number of prescribers or pharmacies visited, without regard to successive and overlapping prescriptions [33] Such methods may overestimate abuse, because successive prescriptions from different prescribers may be legitimately needed, in cancer and palliative care [34], or in similar situations when a general practitioner refers a regular patient to a specialist [35]. A second assessment of doctor shopping from 2000 to 2005 in the same population found that the prescription monitoring program led to a decrease in doctor shopping, without decreasing the access to buprenorphine maintenance treatment [39]

DISCUSSION

Findings

CONCLUSION