https://www.painnewsnetwork.org/stories/2018/3/26/doctor-shopping-has-always-been-rare
A commonly cited factor in the opioid crisis is “doctor shopping” — the act of seeing multiple physicians in order to get an opioid prescription without medical justification. States like Indiana are passing prescribing laws with the specific goal of preventing doctor shopping in an effort to address the opioid crisis.
However, doctor shopping has not at any time in the past decade been a statistically significant factor in the opioid crisis. The National Institute of Drug Abuse tells us that only one out of every 143 patients who received a prescription for an opioid painkiller in 2008 obtained prescriptions from multiple physicians “in a pattern that suggests misuse or abuse of the drugs.” That’s a rate of about 0.7 percent.
The importance of doctor shopping over the last decade was not because of frequency — it has more to do with quantity. Research shows that the 0.7% of people who doctor-shopped were buying about 2 percent of the prescriptions for opioid medications, constituting about 4% of the amount dispensed.
Moreover, these doctor-shoppers tended to be young, to pay in cash, and to see five or six prescribers in a short period of time, so they are easily identifiable and can be thwarted with prescription drug monitoring programs (PDMP’s).
Diversion prevention had long been seen as important. Back in 1999, the Drug Enforcement Administration published “Don’t Be Scammed by a Drug Abuser,” which included advice to doctors and pharmacists on how to recognize drug abusers and prevent doctor-shopping. And states like Washington specifically list doctor shopping among the indicators of opioid addiction in prescribing guidelines, making recognition and intervention key goals for prescribers.
These efforts have paid off. A study in the journal Substance Abuse found that the number of prescriptions diverted fell from approximately 4.30 million (1.75% of all prescriptions) in 2008 to approximately 3.37 million (1.27% of all prescriptions) in 2012. The study concluded that “diversion control efforts have likely been effective.”
Similarly, Pharmacy Times reported a 40% decrease in doctor shopping in West Virginia between 2014 and 2015, thanks in part to efforts by that state’s Board of Pharmacy Controlled Substance Monitoring Program.
The Inspector General of the Department of Health and Human Services found in 2017 that among 43.6 million Medicare beneficiaries, only 22,308 “appeared to be doctor shopping.” That’s a minuscule rate of 0.05 percent.
“You have this narrative that there are these opioid shoppers and rogue prescribers and they’re driving the epidemic, and in fact the data suggests otherwise,” says Dr. Caleb Alexander, who co-authored a 2017 study in the journal Addiction.
“The study found that of those prescribed opioids in 2015, doctor shoppers were exceedingly rare, making up less than one percent of prescription opioid users,” Alexander told Mother Jones.
Doctor shopping is still a problem in other contexts. Opioids are not the only class of medication that people seek to obtain illicitly for a variety of reasons, from hypochondriasis to malingering. PDMPs and other law enforcement efforts have a useful role to play in addressing these issues, and the opioid crisis requires ongoing efforts to prevent drug theft and diversion at all levels of the supply chain.
But claims that doctor shopping is a significant factor in the opioid crisis are mistaken. Doctor shopping was not significant in 2008, and measures to reduce diversion have succeeded, making doctor shopping in 2018 that much rarer.
Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.
The numbers in this article may be LOWER THAN REALITY… everyone functions on the presumption that a healthcare professional is never presented a fake/forged/stolen ID. In fact, the law states that a Pharmacist much be presented a “legal ID”.. from what I have been told, most Rx dept staff looks for the expiration date on the license and other than that… with today’s technology… a semi-dedicated grade schooler could probably produce a passable fake driver’s license. If anyone doubts that .. just do a web search for “how do I get a fake driver’s license” . I just did and got back 8.5 MILLION responses… Let’s presume that 99.99% or duplicates or invalid responses.. that leaves 8,500 that could be valid… all you really need is ONE VALID WEBSITE to get all the fake driver’s licenses that one serious diverter/abuser really needs/wants.
I am not aware of any state, that allows a healthcare provider to access the state’s BMV’s online database to validate a presented driver’s license.. so the pharmacy/pharmacist has no choice but to put into the state’s PMP database .. the driver’s license presented along with a controlled prescriptions.. How many controlled prescriptions would not be written nor dispensed if the healthcare provider had access to the state’s BMV’s online database ?
Scan the driver’s license bar code and if the license presented does not match the graphic of the one issued by the BMV… why would a healthcare provider prescribe or dispense a controlled substance to them… if they are lying about who they are… what else are they misrepresenting ?
The question has to be asked, why wouldn’t let healthcare professionals access to the state’s BMV’s online database for this use ? Is their mindset still in the mid 20th century before the PC revolution… or they are just in denial that it is happening… or they are quite content to keep the “crisis” on going and this could cause “the bureaucracy” to shrink… which in the “bureaucratic world” may be considered a heresy
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