Small Group of Doctor Shoppers Uses Large Amount of Opioids

Patients who fit the criteria of doctor shoppers received an average of 32 prescriptions for opioid painkillers from 10 different doctors in the space of a year, according to the results of a new study.

As the number of deaths caused by opioid overdose continues to rise, a new study funded by the National Institute on Drug Abuse estimates that 4.3 million opioid prescriptions dispensed in 2008 were prescribed to patients who engaged in “doctor shopping.” These patients received an average of 32 prescriptions from 10 different doctors each, leading researchers to strongly suspect they were abusing the drugs.

The study, which was published online on July 17, 2013, in PLOS ONE, estimates the prevalence of patients obtaining multiple opioid prescriptions from several different doctors. The researchers analyzed records from IMS Health, Inc, for 146.1 million prescriptions dispensed in 2008 for opioids containing buprenorphine, codeine/dihydrocodeine, fentanyl, hydrocodone, methadone, oxycodone, oxymorphone, propoxyphene, or tramadol. These drugs were prescribed by 907,782 unique prescribers, dispensed by approximately 37,000 retail pharmacies, and given to 48.4 million unique patients. Data was weighted to represent all prescriptions and patients in the country. The researchers did not have access to diagnostic information and, therefore, could not definitively determine in which cases the prescribed medications were used appropriately.

Among patients using opioids during the first 2 months of 2008, 43% did not use the drugs for the rest of the year. Of those patients who continued to use opioids, 31% received their prescriptions from 1 physician and 14% from 2 physicians. Approximately 3% of patients obtained prescriptions from 5 to 9 prescribers. The researchers estimated that 0.7% of all patients nationwide who were prescribed opioids in the first 2 months of the year were part of an extreme population in terms of their opioid consumption and seeking habits; these patients were presumed to be doctor shoppers.

Although only a small portion of patients fell into the doctor shopper group, these patients obtained approximately 1.9%, or 4.3 million, of the 223 million opioid prescriptions dispensed in 2008, accounting for 4% of all prescribed opioids by weight. The highest risk of abuse was associated with oxycodone, as 2.8% of prescriptions for the medication went to doctor shoppers. Doctor shoppers also used approximately 5.4 million grams of morphine, enough to provide 109 milligrams of the drug to each patient in the group every day of the year. Patients aged 26 to 35 were most likely to be doctor shoppers.

In the absence of clinical data, the researchers cannot confirm their suspicion that patients identified as doctor shoppers are misusing or abusing their prescriptions. They note, however, that even if some of these patients are not using the drugs illicitly, the fact that they are obtaining them from multiple prescribers is at least a sign of uncoordinated care, which can be just as dangerous as intentional abuse.

Many patients find it easy to doctor shop, as physicians frequently have difficulty acquiring information about patients’ prescription histories. To help address this problem, many states have adopted prescription drug monitoring programs, but according to the researchers, physicians often lack the time to 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,” the researchers suggest. They also recommend that physicians screen new patients for drug abuse risk and monitor their adherence to prescriptions.