“Doctor and pharmacy shopping”: A fading signal for prescription opioid use monitoring?

Delcher, Chris; Harris, Daniel R.; Park, Changwe; Strickler, Gail K.; Talbert, Jeffery; Freeman, Patricia R.

doi:10.1016/j.drugalcdep.2021.108618

Cited by 11 publications

(8 citation statements)

References 33 publications

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“…A study conducted by Delcher et al looked at cases and trends of doctor and pharmacy shopping and examined how these can signal potential opioid misuse. 74 Data of patients with prescriptions for controlled substances from 2010 to 2017 were analyzed for cases that would fit the definition of doctor/pharmacy shopping. During the research period, multiple provider encounters declined by 73%.…”

Section: Resultsmentioning

confidence: 99%

“…This study provided evidence that multiple provider encounters are currently declining and that doctor shopping may not be a strong indicator of SUD. 74 Dodson et al conducted a study using spatial modeling to monitor opioid overdoses with an aim to better public health surveillance. 75 This study was conducted in Pittsburgh, PA, from April 2013 to Dec. 2016 and involved 3182 cases of non-fatal opioid overdoses where naloxone was given.…”

Section: Future Researchmentioning

confidence: 99%

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The Role of the Pharmacist in Combating the Opioid Crisis: An Update

Kosobuski

O’Donnell

Sharp

et al. 2022

SAR

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The opioid overdose crisis has claimed hundreds of thousands of lives in the United States in the last decade, with overdose numbers continuing to climb. At the same time, the role of the pharmacist in combating the opioid crisis continues to evolve. Methods: A literature search was conducted in Ovid MEDLINE that incorporated both MeSH terms and keywords to describe two concepts: the opioid epidemic and pharmacists/pharmacies. The search was limited to articles published after 2010 through the end of 2021 and returned 196 articles that were analyzed thematically. Results: Thematic analysis revealed the following themes: prevention, interventions, public health role of the pharmacist, pharmacists in multiple roles, barriers, pharmacist and healthcare provider attitudes, educational initiatives for pharmacists and student pharmacists, and future research. Discussion: While a great deal of progress has been made in the role of the pharmacist in supporting individuals with opioid use disorder (OUD) in the last two decades, pharmacists must seek to invest time and resources into practices with a strong evidence base to better mitigate the growing, devastating impact of the opioid crisis. Pharmacists must be willing to embrace new and non-traditional roles in patient care, service and research, and seek to advance evidence-based knowledge and practice. Conclusion: Pharmacy practice has expanded greatly in the past decade with pharmacists taking on new and creative approaches to addressing the opioid crisis. Collaborative and interdisciplinary approaches to addressing the root causes of opioid misuse and opioid overdose are still desperately needed. These include attention to the critical roles of social determinants of health, stigma elimination, legislative advocacy for patients with OUD, and focused education for providers, pharmacists, and the community. Recognition and support of the value of collaboration to both improve public health and individual patient care, continued investments in pharmacy practice advancement in OUD treatment and harm reduction, and the creation of workflows and prescribing algorithms to assist in dosing medications to prevent withdrawal symptoms and achieve improved pain control are desperately needed.

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Section: Resultsmentioning

confidence: 99%

Section: Future Researchmentioning

confidence: 99%

The Role of the Pharmacist in Combating the Opioid Crisis: An Update

Kosobuski

O’Donnell

Sharp

et al. 2022

SAR

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“…Emerging evidence reveals frequent false positives and limited utility in PDMPs' identification of "doctor and pharmacy shopping"-that is, receipt of opioids from numerous prescribers or pharmacies. 48 In addition, growing evidence suggests that, by reducing prescription opioid access, PDMPs and other policies to curb opioid prescribing could be associated with increased illicit opioid use and overdose. [49][50][51][52][53] Our results raise the possibility of this process occurring disproportionately in Black patients.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the net benefits of reduced opioid dispensing due to supply‐side policies are unclear. Emerging evidence reveals frequent false positives and limited utility in PDMPs' identification of “doctor and pharmacy shopping”—that is, receipt of opioids from numerous prescribers or pharmacies 48 . In addition, growing evidence suggests that, by reducing prescription opioid access, PDMPs and other policies to curb opioid prescribing could be associated with increased illicit opioid use and overdose 49–53 .…”

Section: Discussionmentioning

confidence: 99%

Did prescribing laws disproportionately affect opioid dispensing to Black patients?

Townsend

Bohnert

Lagisetty

et al. 2022

Health Services Research

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Objective To evaluate whether pain management clinic laws and prescription drug monitoring program (PDMP) prescriber check mandates, two state opioid policies with relatively rapid adoption across states, reduced opioid dispensing more or less in Black versus White patients. Data Sources Pharmacy claims data, US sample of commercially insured adults, 2007–2018. Study Design Stratifying by race, we used generalized estimating equations with an event‐study specification to estimate time‐varying effects of each policy on opioid dispensing, comparing to the four pre‐policy quarters and states without the policy. Outcomes included high‐dosage opioids, overlapping opioid prescriptions, concurrent opioid/benzodiazepines, opioids from >3 prescribers, opioids from >3 pharmacies. Data Extraction Methods We identified all prescription opioid dispensing to Black and White adults aged 18–64 without a palliative care or cancer diagnosis code. Principal Findings Exactly 7,096,592 White and 1,167,310 Black individuals met inclusion criteria. Pain management clinic laws were associated with reductions in two outcomes; their association with high‐dosage receipt was larger among White patients. In contrast, reductions due to PDMP mandates appeared limited to, or larger in, Black patients compared with White patients in four of five outcomes. For example, PDMP mandates reduced high‐dosage receipt in Black patients by 0.7 percentage points (95% CI: 0.36–1.08 ppt.) over 4 years: an 8.4% decrease from baseline; there was no apparent effect in White patients. Similarly, while there was limited evidence that mandates reduced overlapping opioid receipt in White patients, they appeared to reduce overlapping opioid receipt in Black patients by 1.3 ppt. (95% CI: −1.66–−1.01 ppt.) across post‐policy years—a 14.4% decrease from baseline. Conclusions PDMP prescriber check mandates but not pain management clinic laws appeared to reduce opioid dispensing more in Black patients than White patients. Future research should discern the mechanisms underlying these disparities and their consequences for pain management.

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“…They generally rely on drug-dispensing data and algorithms to identify patients at risk. Unfortunately, the limited information available can lead to false positives, especially in the case of cancer patients [38].…”

Section: Outside the Healthcare Systemmentioning

confidence: 99%

The Prescription of Drug Ontology 2.0 (PDRO): More Than the Sum of Its Parts

Éthier

Goyer

Fabry

et al. 2021

IJERPH

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While drugs and related products have profoundly changed the lives of people around the world, ongoing challenges remain, including inappropriate use of a drug product. Inappropriate uses can be explained in part by ambiguous or incomplete information, for example, missing reasons for treatments, ambiguous information on how to take a medication, or lack of information on medication-related events outside the health care system. In order to fully assess the situation, data from multiple systems (electronic medical records, pharmacy and radiology information systems, laboratory management systems, etc.) from multiple organizations (outpatient clinics, hospitals, long-term care facilities, laboratories, pharmacies, registries, governments) on a large geographical scale is needed. Formal knowledge models like ontologies can help address such an information integration challenge. Existing approaches like the Observational Medical Outcomes Partnership are discussed and contrasted with the use of ontologies and systems using them for data integration. The PRescription Drug Ontology 2.0 (PDRO 2.0) is then presented and entities that are paramount in addressing this problematic are described. Finally, the benefits of using PDRO are discussed through a series of exemplar situation.

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“Doctor and pharmacy shopping”: A fading signal for prescription opioid use monitoring?

Cited by 11 publications

References 33 publications

The Role of the Pharmacist in Combating the Opioid Crisis: An Update

The Role of the Pharmacist in Combating the Opioid Crisis: An Update

Did prescribing laws disproportionately affect opioid dispensing to Black patients?

The Prescription of Drug Ontology 2.0 (PDRO): More Than the Sum of Its Parts

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