Opioid prescription patterns among patients who doctor shop; Implications for providers

Schneberk, Todd; Raffetto, Brian; Friedman, Joseph; Wilson, Andrew; Kim, David; Schriger, David L.

doi:10.1371/journal.pone.0232533

Cited by 10 publications

(9 citation statements)

References 26 publications

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“…Thus, despite being different, contextually doctor shopping in both countries can lead to increased acquisition of opioids and may increase the utilisation of opioids by people with CNMP, and thus the chances and consequences of opioid related harm remain real. Additionally, this study reports that in Pakistan, people are not just doctor shopping [ 37 , 38 ] but they also might engage in “pill shopping or pharmacy shopping” due to easy availability of medicines without prescriptions as well as lack of electronic prescription or dispensing records.…”

Section: Discussionmentioning

confidence: 99%

Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study

et al. 2022

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Background Opioids are commonly used for the management of chronic non-malignant pain in Pakistan; but there is a lack of literature around precursors or motivators in the use of opioids. Aim The study holistically explored factors contributing towards the unsafe use of opioids and identifies strategies to overcome them. Method Exploratory qualitative methods using interviews, focus groups and non-participant observational case studies were used. Interviews and focus groups were carried out face-to-face as well as virtually and observations were conducted in community pharmacies in Islamabad and Khyber Pukhtoon Khuwa province, Pakistan. Data were collected from 4 stakeholder groups; pharmacy policy makers (n = 11), people with chronic non-malignant pain (n = 14), doctors (n = 31) and community pharmacists (n = 36) by purposive critical case sampling method. Data were analysed inductively using reflexive thematic analysis and then deductively mapped to a social ecological framework. Non-participant observations were analysed using a cross case synthesis using explanation building technique. Data from all three methods were triangulated to develop a logic model. Results Identified factors at macro (regulation), meso (social perceptions of pain and opioids) and micro levels (uncontrolled pain, self-medication, health literacy) and strategies are presented holistically and were used to develop a logic model for the prevention and mitigation of factors currently causing unsafe use of opioids. Conclusion The study provides an in-depth view of factors contributing towards diversion of pharmaceutical opioids and can help guide national and international policy makers in their future initiatives to promote safe use of opioids in the management of chronic non-malignant pain in Pakistan.

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Section: Discussionmentioning

confidence: 99%

Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study

et al. 2022

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“…However, the recent opioid epidemic serves as a reminder of systemic inefficiencies that push patients' voice into unhealthy practices. Unchecked, these inefficiencies are deadly [4]. An example of this can be described by the practice of doctor shopping, which is the practice of individuals visiting several physicians to obtain multiple prescriptions or to attain a preferred medical diagnosis without distinct material gain [4].…”

Section: Rationalementioning

confidence: 99%

“…Unchecked, these inefficiencies are deadly [4]. An example of this can be described by the practice of doctor shopping, which is the practice of individuals visiting several physicians to obtain multiple prescriptions or to attain a preferred medical diagnosis without distinct material gain [4]. It is also defined by imposing a threshold of 6 or more prescriptions from at least 6 different prescribers within 6 months' time [4].…”

Section: Rationalementioning

confidence: 99%

“…An example of this can be described by the practice of doctor shopping, which is the practice of individuals visiting several physicians to obtain multiple prescriptions or to attain a preferred medical diagnosis without distinct material gain [4]. It is also defined by imposing a threshold of 6 or more prescriptions from at least 6 different prescribers within 6 months' time [4]. Such a specific description made our team wonder why health information technology (HIT) could not be leveraged to control for this practice.…”

Section: Rationalementioning

confidence: 99%

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Health Information Technology and Doctor Shopping: A Systematic Review

et al. 2020

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Doctor shopping is the practice of visiting multiple physicians to obtain multiple prescriptions. Health information technology (HIT) allows healthcare providers and patients to leverage records or shared information to improve effective care. Our research objective was to determine how HIT is being leveraged to control for doctor shopping. We analyzed articles that covered a 10-year time period from four databases and reported using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We compared intervention, study design, and bias, in addition to showing intervention interactions with facilitators, barriers, and medical outcomes. From 42 articles published from six countries, we identified seven interventions, five facilitator themes with two individual observations, three barrier themes with six individual observations, and two medical outcome themes with four individual observations. Multiple HIT mechanisms exist to control for doctor shopping. Some are associated with a decrease in overdose mortality, but access is not universal or compulsory, and data sharing is sporadic. Because shoppers travel hundreds of miles in pursuit of prescription drugs, data sharing should be an imperative. Research supports leveraging HIT to control doctor shopping, yet without robust data sharing agreements, the efforts of the system are limited to the efforts of the entity with the least number of barriers to their goal. Shoppers will seek out and exploit that organization that does not require participation or checking of prescription drug monitoring programs (PDMP), and the research shows that they will drive great distances to exploit this weakest link.

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“…With the exception of a reduction in prescription opioid-related death rates [ 18 , 19 ], evidence of their efficacy has been weak [ 20 – 23 ]. Patients that doctor shop for opioids generally receive prescriptions from high volume prescribers [ 24 , 25 ] and do not receive a significant supply from episodic providers, thus potentially negating the effectiveness of prescription reduction efforts at episodic settings [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Assessing the impact of Indiana legislation on opioid-based doctor shopping among Medicaid-enrolled pregnant women: a regression analysis

Joshi

Adams

Yih

et al. 2021

Subst Abuse Treat Prev Policy

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Background States have passed various legislative acts in an attempt to reduce opioid prescribing and corresponding doctor shopping, including prescription drug monitoring programs. This study seeks to determine the association between two state-based interventions enacted in Indiana and the level of doctor shopping among Medicaid-enrolled pregnant women. Methods Indiana Medicaid claims data over the period of January 2014 to March 2019 were used in a regression model to determine the longitudinal change in percentage of pregnant women engaged in doctor shopping based on passage of Indiana Administrative Code Title 884 in 2014 and Public Law 194 in 2018. The primary reasons for prescribing were also identified. Results There were 37,451 women that had both pregnancy and prescription opioid claims over the time horizon. Of these, 2130 women met the criteria for doctor shopping. Doctor shopping continued to increase over the time between the passage of the two interventions but decreased after passage of Public Law 194. Conclusion The decrease in doctor shopping among Medicaid-enrolled pregnant women after passage of Public Law 194 points to the importance of addressing this issue across a broad set of healthcare professionals including nurse practitioners and physician assistants. It is also possible that the potential punitive component in the Law for non-compliance played a role.

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Opioid prescription patterns among patients who doctor shop; Implications for providers

Cited by 10 publications

References 26 publications

Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study

Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study

Health Information Technology and Doctor Shopping: A Systematic Review

Assessing the impact of Indiana legislation on opioid-based doctor shopping among Medicaid-enrolled pregnant women: a regression analysis

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