Estimating the Prevalence of ‘Doctor Shopping' for Prescription Drugs
- Doctor shopping’s contribution to opioid misuse wasn’t well understood.
- Abt used a novel statistical method to analyze 146.1 million prescriptions.
- Drug monitoring programs must improve to address suspicious opioid purchasing patterns.
Misuse of opioid analgesics threatens public health and results in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. In the absence of adequate patient information systems, patients who engage in “doctor shopping” can obtain multiple opioid prescriptions for nonmedical use from a number of unaware physicians. The extent of doctor shopping and its contribution to the growing epidemic of opioid misuse was insufficiently understood.
Through a grant from the National Institute on Drug Abuse, Abt undertook a study that estimated the prevalence of doctor shopping in the United States and the amounts and types of opioids involved. Abt researchers examined a sample that included 146.1 million opioid prescriptions dispensed during 2008 by 76 percent of retail pharmacies in the United States. Using a novel statistical method, they developed national, state and county estimates for the first time.
Abt found that outlier patients presumed to be doctor shoppers – 0.7 percent of purchasers – obtained on average 32 opioid prescriptions from 10 prescribers during 2008. These patients bought an estimated 4.3 million prescriptions, about four percent of prescribed opioids by weight. The results supported a recommendation that prescription drug monitoring programs improve access and response time, scan prescription data to flag suspicious purchasing patterns and increase practitioner participation. Practitioners should screen new patients for risk of abuse and monitor adherence to treatment. A companion study of variation in physicians’ prescribing practices, using the same data, suggested insufficient guidance to prescribers was a more significant contributor to the epidemic than doctor shopping patients were.
Read more about this work:
- Abt Associates’ “Doctor Shopping” Paper Earns Award at Upcoming Scientific Meeting
- Study Estimates that 4.3 Million Prescriptions for Painkillers Were Diverted to Illicit Use by Doctor Shoppers
- The ecology of prescription opioid abuse in the USA: geographic variation in patients' use of multiple prescribers
- Geographic Variation in Opioid Prescribing in the U.S.
- An Experimental Test of the Effectiveness of Unsolicited Reporting by a Prescription Drug Monitoring Program in Reducing Inappropriate Acquisition of Opioids
- Supporting Development, Dissemination and Implementation of the CDC Opioid Prescribing Guideline