“Doctor Shopping” and the Opioid Epidemic

In the battle against the opioid epidemic, one of the most widely discussed areas of concern is unsafe prescribing practices in the United States. Many people have the availability to receive opioid prescriptions pills in excess through “doctor shopping”.

What is Doctor Shopping?

In the world of opioid prescriptions, more is more. Doctor shopping is the action of going to multiple different doctors and pharmacies to get as many different, or same prescriptions as possible.  There are a variety of different reasons why people do this, but primarily, it revolves around addiction and illegal distribution.

So to navigate around “limits” on how many prescriptions one doctor can write, people go to a handful of doctors, and sometimes more than a handful, so they can have double, sometimes triple the number of prescription medications. This usually leads to drug dependence and addiction.

The Dangers of Doctor Shopping

While it might not seem like a punishable offense for people to have as many medications as they want or think they need, there is often a whole slew of dangers that can come with doctor shopping.

Primarily, doctors only prescribe a certain number of pills, a certain dosage, and a certain combination of multiple prescriptions at once, because any other mix has the potential to be deadly. When a patient receives medications from one doctor for a certain medical concern, that prescriber has particularly chosen that medication based on the person’s medical history, with consideration of any other medications that the patient has been honest about.

However, since doctor shopping is illegal, people who do it will never tell a prescriber what other kinds of medication they are prescribed, so that they can obtain more.

This quality of doctor shopping and mixing medications is one of the most common reasons why people suffer from accidental overdoses.

Real Life Accounts

Doctor shopping has become extremely common, and somewhat of a plague on the healthcare community. This trend has helped to fuel addiction rates, illegal drug sales, overdoses, and deaths.

There are countless doctor shopping arrests made every day throughout the United States, and it happens everywhere from busy city hubs to rural countrysides. NPR released findings and reports of the dangers of the prevalence of doctor shopping, here are some of their findings:

• According to the U.S Department of Health and Human Services, at least 22,000 Medicare beneficiaries seem to be doctor shopping.
• In the same report, it was found that more than 500,000 Medicare patients received “high doses” of opioid prescriptions, meaning they received the equivalent of 12 tablets a day of Vicodin 10 mg.
• A Medicare-covered patient filled over 2,300 oxycodone, hydromorphone, and morphine prescriptions in a single month in 2016. This person had prescriptions from over 42 different doctors and medical prescribers.
• An Illinois Medicare patient 73 different opioid prescriptions, from 11 different prescribers, and filled them over 20 different pharmacies.

Prescription Monitoring Programs

Since the announcement of the opioid epidemic becoming a National Health Emergency, local lawmakers and the White House have been working together to try to crack down on doctor shopping and unsafe prescribing practices.

As of 2014, 36 states have implemented prescription-drug monitoring programs (PDMP) as a way to reduce the rates of doctor shopping and overprescribing. It works by keeping track of each individual and the medications are prescribed, how many, when, what dosage, and the medical professional that prescribed them.

This database makes it possible for a prescriber with a new patient to look up and verify for themselves that the individual is not doctor shopping, or will not have any other medications that could potentially make a new one life-threatening.

According to a study performed by the Substance Abuse and Mental Health Services Administration, states that used a prescription-drug monitoring program had much lower rates of overprescribing. For example, in these states where physicians were mandated to check the patient’s prescription history in the database the odds of two or more doctors prescribing pain relievers to a single patient were reduced by 80%!

The Downsides of PDMP

While it seems that all states would be required to participate in prescription-drug monitoring programs and databases, that is actually not the case. As of now, it is not a federally mandated law for states to utilize these databases, and it is also not a law for prescribers to use them.

Many doctors who have been found guilty of over-prescribing have admitted that they were aware that the patient was receiving prescriptions from another doctor. Sometimes, greed can come before the wellbeing of the patient in today’s medical world.

In addition, many doctors hold a certain amount of skepticism towards these databases and doubt the accuracy of updates and the information that people can provide. According to a study performed by the professor of pharmaceutical outcomes and policy at the University of Florida, David Brushwood, many prescribers find utilizing the database to “time consuming” and “unnecessary”.

According to that same study, a large majority of the medical facilities that were researched go more by their own instincts and their own addiction screenings. They use body language cues, any signs of physical withdrawal symptoms, and lengthy evaluation charts to decide if a person is at risk of addiction or could potentially be doctor shopping.

On the other hand, many people are concerned that a nationwide implementation of prescription drug monitoring databases will encourage more people to move away from doctor prescriptions and move towards illegal street drugs such as heroin. However, the same study did track the possibility, and reportedly found no evidence that implemented these databases would lead to more illegal drug use.

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