Abstract
BackgroundAbuse of prescription opioid analgesics is a serious threat to public health, resulting in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. Absent adequate patient information systems, “doctor shopping” patients can obtain multiple opioid prescriptions for nonmedical use from different unknowing physicians. Our study estimates the prevalence of doctor shopping in the US and the amounts and types of opioids involved.Methods and FindingsThe sample included records for 146.1 million opioid prescriptions dispensed during 2008 by 76% of US retail pharmacies. Prescriptions were linked to unique patients and weighted to estimate all prescriptions and patients in the nation. Finite mixture models were used to estimate different latent patient populations having different patterns of using prescribers. On average, patients in the extreme outlying population (0.7% of purchasers), presumed to be doctor shoppers, obtained 32 opioid prescriptions from 10 different prescribers. They bought 1.9% of all opioid prescriptions, constituting 4% of weighed amounts dispensed.ConclusionsOur data did not provide information to make a clinical diagnosis of individuals. Very few of these patients can be classified with certainty as diverting drugs for nonmedical purposes. However, even patients with legitimate medical need for opioids who use large numbers of prescribers may signal dangerously uncoordinated care. To close the information gap that makes doctor shopping and uncoordinated care possible, states have created prescription drug monitoring programs to collect records of scheduled drugs dispensed, but the majority of physicians do not access this information. To facilitate use by busy practitioners, most monitoring programs should improve access and response time, scan prescription data to flag suspicious purchasing patterns and alert physicians and pharmacists. Physicians could also prevent doctor shopping by adopting procedures to screen new patients for their risk of abuse and to monitor patients' adherence to prescribed treatments.
Highlights
Since the mid-1990s, misuse of prescription drugs has emerged as a serious threat to public health in the US
In 2009, an estimated one in seven US residents aged 12 and older admitted to past nonmedical use of opioids, meaning not as prescribed by an informed physician [8]
Diagnostic or other clinical information was not available, which limited our ability to distinguish medically appropriate from suspicious patterns of opioid purchasing. (Having diagnostic information might improve the indicators of appropriate prescribing and of doctor shopping, but because doctor shoppers present false symptoms, and sometimes even falsified MRI reports, each prescription will be associated with a diagnosis that looks legitimate [34].)
Summary
Since the mid-1990s, misuse of prescription drugs has emerged as a serious threat to public health in the US. In 2009, an estimated one in seven US residents aged 12 and older admitted to past nonmedical use of opioids, meaning not as prescribed by an informed physician [8]. This is not just an American problem. Abuse of prescription opioid analgesics is a serious threat to public health, resulting in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. Our study estimates the prevalence of doctor shopping in the US and the amounts and types of opioids involved
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