Abstract
Use of multiple prescribers and pharmacies is a means by which some individuals misuse opioids. Community characteristics may be important determinants of the likelihood of this phenomenon independent of individual-level factors. This was a retrospective cohort study with individual-level data derived from California's statewide prescription drug monitoring program (PDMP) and county-level socioeconomic status (SES) data derived from the United States Census. Zero-truncated negative binomial (ZTNB) regression was used to model the association of individual factors (age, gender, drug schedule and drug dose type) and county SES factors (ethnicity, adult educational attainment, median household income, and physician availability) with the number of prescribers and the number of pharmacies that an individual used during a single year (2006). The incidence rates of new prescriber use and new pharmacy use for opioid prescriptions declined across increasing age groups. Males had a lower incidence rate of new prescriber use and new pharmacy use than females. The total number of licensed physicians and surgeons in a county was positively, linearly, and independently associated with the number of prescribers and pharmacies that individuals used for prescription opioids. In summary, younger age, female gender, and living in counties with more licensed physicians and surgeons were associated with use of more prescribers and/or more pharmacies for obtaining prescription opioids.
Highlights
Acute and chronic pain affect over 100 million adults in the United States [1]
After combining the California PMP data with US census data, we examined the associations of individual-level and county-based factors with use of multiple prescribers and pharmacies for prescription opioids in California during 2006
The physician availability had a positively linear relationship with the number of prescribers and pharmacies that patients used in 2006. Other neighborhood factors such as ethnicity, educational attainment, and median household income had either small or inconsistent association, which may be due to influences from unmeasured factors
Summary
The annual economic cost associated with chronic pain is estimated at $560–635 billion [1]. Opioid analgesics have been acknowledged to be an effective treatment to control moderate to severe pain while simultaneously improving quality of life [2]. According to national surveillance reports in 2009, 35 million US residents aged 12 years or older reported non-medical use of opioids at least once during their lifetime [3]. The annual financial cost of prescription opioid abuse is estimated at about $10 billion [4]. The use of multiple prescribers (‘‘doctor shopping’’) is one of the most common methods that drug abusers and dealers employ to obtain prescription opioids for non-medical use [5,6]. Identifying highrisk individuals for doctor shopping will play a significant role in controlling abuse and diversion of prescription opioids
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