For most people, “doctor shopping” means that period of time when insurance changes or a doctor retires and finding a new doctor becomes necessary. For others, doctor shopping is the dangerous and potentially lethal practice of obtaining and filling multiple prescriptions from different doctors and pharmacies. Although this practice is not widespread, it can result in fatal overdoses, dependence, and an inaccurate view of prescription trends.
Doctor shopping is practiced most commonly for the following medications:
- Muscle relaxers
- Attention deficit or attention deficit hyperactivity disorder (ADD or ADHD) medications
People who are doctor shopping do so in a variety of ways. They may go to urgent care centers with symptoms that will help get them the prescriptions they want, varying their story just enough to avoid arousing suspicion. Doctor shoppers also utilize multiple pharmacies, avoiding large pharmaceutical chains that might keep traceable electronic records. Once medications are obtained, doctor shoppers may either stockpile large amounts of prescription drugs, or they may sell them.
For some, doctor shopping is a straight line to dependence on powerful opioid medications. A recent study presented at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that one in five postoperative orthopedic patients were doctor shopping, resulting in narcotic use that lasted an average of four times longer than other patients who were having prescriptions filled by a single doctor or pharmacy. The number of prescriptions filled by doctor shopping patients was nearly four times higher, with an average of seven prescriptions (as compared to two for other patients). Patients with a history of drug dependence (either personal or family history) were 4.5 times more likely to practice doctor shopping than those patients with no history of drug abuse or dependence.
New estimates in the April 2015 issue of PAIN®, the official journal of the International Association for the Study of Pain, report that 20-30% of prescription opioids for chronic pain are misused, with the rate of addiction estimated at approximately 10% of opioid users. These estimates were put together using data from 38 different reports, many of which indicated a rise in opioid prescription rates.
But does this mean that more people are using opioids? Not necessarily.
Dr. Douglas McDonald and Kenneth Carlson of the research firm Abt Associates, Inc., of Cambridge, Massachusetts gathered information from a dataset of over 146 million prescription records and found that while doctor shoppers made up just 0.7% of those with opioid prescriptions, they were responsible for filling 2% of all opioid prescriptions in the U.S. This group of approximately 135,000 individuals purchased an average of 11.1 million grams of prescription opioids, which breaks down to 109 milligrams per day, every day, all year, per patient. A dose of 100 milligrams a day puts a patient at high risk for overdose.
While this number of people may represent a small fraction of people taking prescription opioids in the U.S., chances are good that they did not plan on doctor shopping when they first suffered an injury or were diagnosed with chronic pain. There are, however, some warning signs or early red flags that patients, families, and physicians need to be aware of. These may not indicate that a patient will automatically start doctor shopping, but the presence of any of these factors means that the patient should be carefully monitored during the course of treatment.
- Previous history of drug dependence: Dependence on any type of drug, including opioids, muscle relaxants, or even alcohol is of primary concern when prescribing opioids.
- Family history of drug dependence: There is some indication that addiction is genetic, so patients with family history of addiction should be carefully monitored.
- Presence of psychiatric disorders: Conditions such as depression and anxiety may contribute to dependence.
- Onset of condition: If the chronic pain condition or injury occurs at a younger age, the patient is more likely to become dependent and to investigate the possibility of doctor shopping. The Abt Associates study found that doctor shopping behavior peaked between the ages of 26 and 35.
- Located in a state with no prescription drug monitoring program (PDMP) or with a program that is not fully implemented: Currently 49 states and the District of Columbia have PDMPs, but not all are effectively administered. The presence of a well-executed PDMP is a strong deterrent for doctor shopping.
Warning signs of potential doctor shopping can include the following:
- Multiple pill bottles from different pharmacies or doctors
- No clear relief of symptoms: The patient is still complaining of intense pain long after an acute injury should have healed, or a chronic pain patient is not able to obtain any relief with increasing doses of medication
- Reluctance to discuss symptoms
- Withdrawal from normal activities, or other change in behavior
If you suspect that a loved one may be doctor shopping, it is important to get them help as soon as possible.
A chronic pain diagnosis makes opioids and opioid dependence much more complicated. If your loved one has chronic pain, the potential withdrawal from opioids can make the pain even worse while adding other side effects such as nausea, dizziness, and anger or irritability. It is important to work with a doctor to help minimize these side effects as much as possible while reducing opioid use.
The first step of helping a loved one stop doctor shopping and end their dependence is to have a conversation with them about the consequences of their dependence on their friends, family, and children. It may be helpful to work in conjunction with a mental health professional, as the roots of addiction often go much deeper than just the physical. Finding support for your loved one – physical, mental, and emotional – is crucial during this time.
Doctor shopping is a sign of a deeper issue, often rooted in past trauma or current pain. If you or a loved one are doctor shopping, talk to your doctor and get help today.
Image by Mike Mozart via Flickr