Collaboration or Coercion? Partnering to Divert Prescription Opioid Medications

Green, Traci C.; Bowman, Sarah; Ray, Madeline; Zaller, Nickolas; Heimer, Robert; Case, Patricia

doi:10.1007/s11524-012-9784-5

Cited by 21 publications

(13 citation statements)

References 23 publications

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“…Patterns of doctor shoppers identified by the prescribers in this study such as traveling out of town to see prescribers, describing symptoms that can only be treated with controlled medications, and exhibiting extreme emotional responses are similar to those of other studies and can be used to develop interventions and policies that can be implemented when controlled medications are prescribed (Green et al, 2013;Rigg et al, 2012;Worley & Thomas, 2014).…”

Section: Resultssupporting

confidence: 56%

Psychiatric Prescribers’ Experiences With Doctor Shoppers

Worley

Johnson

Karnik

2015

J Am Psychiatr Nurses Assoc

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Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs.

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Section: Resultssupporting

confidence: 56%

Psychiatric Prescribers’ Experiences With Doctor Shoppers

Worley

Johnson

Karnik

2015

J Am Psychiatr Nurses Assoc

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“…Persons unlawfully using prescription opioids commonly obtain them from friends, family, and drug dealers. [20][21][22] Patients with such prescription histories put themselves at risk, but might also have contributed to the deaths of others who had no opioid prescriptions in the TNCSMP (more than one-third of decedents did not have a prescription in the TNCSMP).…”

Section: Discussionmentioning

confidence: 99%

High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths

et al. 2014

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Tennessee increased from 422 to 1059 per year. More of these deaths involved prescription opioids than heroin and cocaine combined.OBJECTIVE To assess the contribution of certain opioid-prescribing patterns to the risk of overdose death. DESIGN, SETTING, AND PARTICIPANTSWe performed a matched case-control study that analyzed opioid prescription data from the Tennessee Controlled Substances Monitoring Program (TNCSMP) from January 1, 2007, through December 31, 2011, to identify risk factors associated with opioid-related overdose deaths from January 1, 2009, through December 31, 2010. Case patients were ascertained from death certificate data. Age-and sex-matched controls were randomly selected from among live patients in the TNCSMP. MAIN OUTCOMES AND MEASURESWe defined a high-risk number of prescribers or pharmacies as 4 or more per year and high-risk dosage as a daily mean of more than 100 morphine milligram equivalents (MMEs) per year. The main outcome was opioid-related overdose death.

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“…Diversion of prescription opioids is a widespread problem in the US. Diversion can occur at any point in the drug delivery process from the manufacturing site to the physician's office, the retail pharmacy, or the patient, and common sources include doctor shopping, pill brokering, and siphoning from the family medicine chest 2,3 . The primary sources of prescription opioids on the street include the elderly, patients with pain, doctor shoppers, and pill brokers and dealers 4 .…”

Section: Introductionmentioning

confidence: 99%

Sources of prescription opioids among diagnosed opioid abusers

Shei

Rice

Kirson

et al. 2015

Current Medical Research and Opinion

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Objective: Diversion and abuse of prescription opioids are important public health concerns in the US. This study examined possible sources of prescription opioids among patients diagnosed with opioid abuse. Methods:Commercially insured patients aged 12-64 diagnosed with opioid abuse/dependence ('abuse') were identified in OptumHealth Reporting and Insights medical and pharmacy claims data, 2006-2012, and required to have continuous eligibility over an 18 month study period surrounding the first abuse diagnosis. We examined whether abusers had access to prescription opioids through their own prescriptions and/or to diverted prescription opioids through family members' prescriptions obtained prior to the abuser's first abuse diagnosis. For comparison, we examined access to prescription opioids of a reference population of non-abusers. Sensitivity analyses focused on patients initially diagnosed with opioid dependence and, separately, abusers not previously treated with buprenorphine. Results:Of the 9291 abusers meeting the selection criteria, 79.9% had an opioid prescription prior to their first abuse diagnosis; 20.1% of abusers did not have an opioid prescription prior to their first abuse diagnosis, of whom approximately half (50.8%) had a family member who had an opioid prescription prior to the abuser's first abuse diagnosis (compared to 42.2% of non-abusers). Similar results were found among patients initially diagnosed with opioid dependence and among abusers not previously treated with buprenorphine. Limitations:The study relied on the accuracy of claims data to identify abusers, but opioid abuse is often undiagnosed. In addition, only prescription claims that were reimbursed by a health plan were included in the analysis. Conclusions:While most abusers had access to prescription opioids through their own prescriptions, many abusers without their own opioid prescriptions had access to prescription opioids through family members and may have obtained prescription opioids that way. Given the study design and data source, this is likely a conservative estimate of prescription opioid diversion.

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Collaboration or Coercion? Partnering to Divert Prescription Opioid Medications

Cited by 21 publications

References 23 publications

Psychiatric Prescribers’ Experiences With Doctor Shoppers

Psychiatric Prescribers’ Experiences With Doctor Shoppers

High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths

Sources of prescription opioids among diagnosed opioid abusers

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