Pharmacy Board Actions Decrease "Doctor Shopping" in West Virginia

When the administrator for the West Virginia Board of Pharmacy Controlled Substance Monitoring Program (CSMP) scanned the state’s prescription database in 2014, he uncovered a sobering number of suspected “doctor shoppers.”

In West Virginia, a “doctor shopper” is defined as a patient who receives 10 or more prescriptions for controlled substances and gets them filled by 5 different dispensers within a 6-month period.

When such a patient is identified, CSMP sends letters directly to the prescribers and pharmacies involved that detail the specific case, CSMP Administrator Michael L. Goff explained to Pharmacy Times. In cases of drug overdose death where prescription activity raises suspicion, CSMP also sends letters to law enforcement and/or licensing boards containing information about the decedent, the practitioner, and the drugs implicated in the death.

CSMP sent a total of 1150 letters to prescribers and pharmacists in 2014, the same year that the US Centers for Disease Control and Prevention deemed West Virginia the state with the highest number of prescription drug overdoses, at a rate of 35.5 related deaths per 100,000 individuals.

Now, more recent state data show a 40% decrease in “doctor shopping” over the past 2 years, which Goff believes is likely due at least in part to the CSMP letters.

“We believe that these letters have increased awareness of the practitioners about the issue,” he said. “Utilization of the CSMP also continues to increase.”

Other efforts in West Virginia may also be contributing to the reduction in the number of patients seeking opioids and other controlled substances from multiple prescribers.

Early in January 2016, West Virginia’s attorney general filed a claim against one of the country’s largest drug distributors for allegedly failing to curb suspicious orders for controlled substances.

An investigation orchestrated by the state’s Attorney General uncovered that McKesson distributed about 99.5 million doses of hydrocodone and oxycodone to West Virginia between 2007 and 2012. The 10.2 million doses shipped to Logan County alone translated to an average of more than 276 doses per area resident.

Meanwhile, West Virginia’s prescription drug abuse problem has had negative implications for pharmacists. Just last year, the state’s highest appellate court ruled that drug abusers can sue pharmacists for enabling their addictions.

West Virginia Pharmacists Association Executive Director Richard Stevens told Pharmacy Times that this ruling put pharmacists in harm’s way.

“Pharmacists can only protect themselves by exercising extreme caution in dispensing controlled substances—especially those products known to be abused—to individuals who are not patrons of their pharmacy. They will have to alert prescribing physicians if their patients are obtaining excessive quantities of controlled substances from other prescribers,” he noted. “This will certainly increase pharmacists’ workload.”