Doctor shopping among chronic noncancer pain patients treated with opioids in the province of Quebec (Canada): incidence, risk factors, and association with the occurrence of opioid overdoses

Kaboré, Jean‐Luc; Pagé, M. Gabrielle; Dassieu, Lise; Tremblay, Éric; Benigeri, Mike; Roy, Denis; Lacasse, Anaïs; Choinière, Manon

doi:10.1097/pr9.0000000000000955

Cited by 7 publications

(6 citation statements)

References 43 publications

(68 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, the significant contribution of the number of prescribers concords with prior research 13 . The significance of multiple providers and high healthcare use has been attributed to doctor shopping, where patients visit multiple physicians to obtain multiple opioid prescriptions 51–53 . However, the 1‐year prevalence of opioid doctor shopping in Quebec in chronic noncancer pain is low (7%), represented mostly by young males with anxiety 52 .…”

Section: Discussionmentioning

confidence: 89%

“…13 The significance of multiple providers and high healthcare use has been attributed to doctor shopping, where patients visit multiple physicians to obtain multiple opioid prescriptions. [51][52][53] However, the 1-year prevalence of opioid doctor shopping in Quebec in chronic noncancer pain is low (7%), represented mostly by young males with anxiety. 52 These findings are still of strong importance given that in Quebec, 30% of individuals are not attached to a GP, and may consult walk-in clinics or emergency departments when health services are required, which may in part be contributing to the problem of opioid use and PIOU, 54 although this is more likely to affect middle-aged individuals.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Factors associated with potentially inappropriate opioid use in community‐living older adults consulting in primary care

D’Aiuto

Lunghi

Guénette

et al. 2022

Int J Geriat Psychiatry

View full text Add to dashboard Cite

Objective To study the factors associated with opioid use and potentially inappropriate opioid use (PIOU) in primary care older adults with non‐cancer pain referring to the conceptual framework developed by the American Agency for Healthcare Research and Quality. Methods This is a secondary analysis of health survey and medico‐administrative data from Québec, Canada. Individuals aged ≥65 were recruited between 2011 and 2013 in primary care clinics to participate in face‐to‐face interviews. The sample included 945 older adults without a malignant tumor over the study period or any tumor in the 2 years surrounding opioid use. Opioid use within a 3 year follow‐up period was identified from the public drug plan database. Potentially inappropriate opioid use (PIOU) was defined using the American Geriatrics Society Beers 2019 list. Multinomial regression analyses were performed to study the factors (patient, pain, substance use, provider, healthcare system) associated with opioid use and PIOU. Results In this sample of older adults, 26.2% used an opioid and 18.4% were categorized as PIOU. Factors associated with PIOU compared to opioid use included female sex, higher psychological distress, number of emergency department visits, and recruitment type of healthcare practice. Factors associated with PIOU compared to no use included female sex, country of origin, presence of a trauma, physical/psychiatric multimorbidity, number of outpatient consultations, pain severity/type, and number of prescribers. Conclusions Mental health and health system factors were associated with PIOU. Results highlights the importance of a multidisciplinary approach for pain management, and the urgent need for implementing organizational efforts to optimize opioid use in primary care.

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Factors associated with potentially inappropriate opioid use in community‐living older adults consulting in primary care

D’Aiuto

Lunghi

Guénette

et al. 2022

Int J Geriat Psychiatry

View full text Add to dashboard Cite

show abstract

“…For example, Schneberk et al 10 defined COPs as those who received greater than 6 or more prescriptions from at least 6 different prescribers within 6 months. Kaboré et al 26 defined a COP as an individual with at least 1 day of overlapping prescriptions written by at least 2 different prescribers and filled in at least 3 different pharmacies. Our selection of the time window to identify COP considered the average number of days of opioid analgesic supply to treat acute pain.…”

Section: Methodsmentioning

confidence: 99%

Assessing the Impact of Indiana Public Law 194 on Curbing the Concurrent Opioid Prescribing for Indiana Medicaid Enrollees

et al. 2023

View full text Add to dashboard Cite

Background: Several US states have introduced legislation to support the legitimate medical use of opioids while limiting misuse and diversion. One concern which has been addressed through legislation is preventing individuals from seeking opioid prescriptions concurrently from multiple providers. However, the impact of this legislation on the incidence of patients receiving concurrent prescriptions remains relatively unexplored. This study examines this phenomenon based on claims data from Medicaid enrollees and the enactment of legislation in Indiana. Methods: Indiana Medicaid claims data over the period of January 2014 to December 2019 were used to determine the changes in the percentage of individuals receiving opioid prescriptions from multiple providers within a 30-day period, that is, concurrent opioid prescription (COP) individuals. Indiana Medicaid enrollees with a diagnosis of opioid use disorder (OUD) receiving opioid prescriptions, that is, the OUD-group, were identified and separated from the enrollees without a diagnosis but receiving opioid prescriptions, that is, the non-OUD group. The mean percentages of COP individuals (with or without an OUD diagnosis) within the subset of individuals that received opioid prescriptions were compared before and after the passage of Indiana Public Law 194. Results: There were 5336 who met the criteria of COP individuals, and 2050 of those were in the OUD-group. In either group, there was a significant difference in the change in percentages (slope) before and after Indiana Public Law 194 passed. In addition, there was a significant decrease in the mean percentage of COP individuals in the non-OUD group, while the difference was not significant in the OUD group. Conclusion: Our study suggests that Indiana Public Law 194 had a positive impact on curbing COP. This study is limited by the level of details available from claims data and suggests additional studies to evaluate prescription use and prescribing practices are warranted.

show abstract

“…When patients with a prior drug abuse and addiction history were excluded, approximately 0.19% developed abuse and addiction to prescribed opioids [83]. A 2019 Cochran review reported signs of addiction in 0.27% of patient on long-term opioid therapy for NCRP [78], A 2021 Canadian study [84] identified doctor shopping in only 7.8%. When addiction was present it did not appear to correlated with opioid prescribing patterns.…”

Section: Abuse/addictionmentioning

confidence: 99%

The Role of Cognitive Biases in the Prescribing and Deprescribing of Opioids

Doleys¹

2022

Curr Res Psychol Behav Sc

View full text Add to dashboard Cite

The policies and guidelines which have shaped the attitude and practice relating to the use of opioids for the treatment of chronic pain have undergone remarkable changes. Recent decades have witnessed a surge, followed by a decline, and near prohibition, in the use of opioids. Cognitive biases appeared to be play an important role in how the scientific data upon which policy and guidelines are based is presented, and interpreted. These biases may have had a greater influence on policymakers than the data itself. This paper reviews data from four key areas identified as relating to the use of opioids, and the creation of guidelines including (a) the surge and decline in opioid prescribing, (b) sham distinctions, (c) reliance on the numerical pain rating (NPR) and (d) the consequences associated with the use/discontinuation of opioids. Published studies, commentaries, and guidelines were selected based on their ability to illustrate a particular bias and/or to highlight discrepancies in the scientific literature. Discrepancies and inconsistences in the presentation and interpretation of data in these areas were identified. Focused illusion, linguistic uncertainty, and heuristic failure were found to be prevalent cognitive biases. Cognitive biases appear to be influential in the making of policy and guidelines related to the sue of opioids. Overlooking these biases may result in decisions that negatively impact clinical practice and patient safety

show abstract

Doctor shopping among chronic noncancer pain patients treated with opioids in the province of Quebec (Canada): incidence, risk factors, and association with the occurrence of opioid overdoses

Cited by 7 publications

References 43 publications

Factors associated with potentially inappropriate opioid use in community‐living older adults consulting in primary care

Factors associated with potentially inappropriate opioid use in community‐living older adults consulting in primary care

Assessing the Impact of Indiana Public Law 194 on Curbing the Concurrent Opioid Prescribing for Indiana Medicaid Enrollees

The Role of Cognitive Biases in the Prescribing and Deprescribing of Opioids

Contact Info

Product

Resources

About