Estimating the prevalence of opioid diversion by "doctor shoppers" in the United States.

<h4>Background</h4>Abuse of prescription opioid analgesics is a serious threat to public health, resulting in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. Absent adequate patient information systems, "doctor shopping" patie...

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Autores principales:	Douglas C McDonald, Kenneth E Carlson
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/ed09a7f713ab4b33ad985253145a7dad
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spelling	oai:doaj.org-article:ed09a7f713ab4b33ad985253145a7dad2021-11-18T07:37:21ZEstimating the prevalence of opioid diversion by "doctor shoppers" in the United States.1932-620310.1371/journal.pone.0069241https://doaj.org/article/ed09a7f713ab4b33ad985253145a7dad2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23874923/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Abuse of prescription opioid analgesics is a serious threat to public health, resulting in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. Absent adequate patient information systems, "doctor shopping" patients can obtain multiple opioid prescriptions for nonmedical use from different unknowing physicians. Our study estimates the prevalence of doctor shopping in the US and the amounts and types of opioids involved.<h4>Methods and findings</h4>The sample included records for 146.1 million opioid prescriptions dispensed during 2008 by 76% of US retail pharmacies. Prescriptions were linked to unique patients and weighted to estimate all prescriptions and patients in the nation. Finite mixture models were used to estimate different latent patient populations having different patterns of using prescribers. On average, patients in the extreme outlying population (0.7% of purchasers), presumed to be doctor shoppers, obtained 32 opioid prescriptions from 10 different prescribers. They bought 1.9% of all opioid prescriptions, constituting 4% of weighed amounts dispensed.<h4>Conclusions</h4>Our data did not provide information to make a clinical diagnosis of individuals. Very few of these patients can be classified with certainty as diverting drugs for nonmedical purposes. However, even patients with legitimate medical need for opioids who use large numbers of prescribers may signal dangerously uncoordinated care. To close the information gap that makes doctor shopping and uncoordinated care possible, states have created prescription drug monitoring programs to collect records of scheduled drugs dispensed, but the majority of physicians do not access this information. To facilitate use by busy practitioners, most monitoring programs should improve access and response time, scan prescription data to flag suspicious purchasing patterns and alert physicians and pharmacists. Physicians could also prevent doctor shopping by adopting procedures to screen new patients for their risk of abuse and to monitor patients' adherence to prescribed treatments.Douglas C McDonaldKenneth E CarlsonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 7, p e69241 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Douglas C McDonald Kenneth E Carlson Estimating the prevalence of opioid diversion by "doctor shoppers" in the United States.
description	<h4>Background</h4>Abuse of prescription opioid analgesics is a serious threat to public health, resulting in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. Absent adequate patient information systems, "doctor shopping" patients can obtain multiple opioid prescriptions for nonmedical use from different unknowing physicians. Our study estimates the prevalence of doctor shopping in the US and the amounts and types of opioids involved.<h4>Methods and findings</h4>The sample included records for 146.1 million opioid prescriptions dispensed during 2008 by 76% of US retail pharmacies. Prescriptions were linked to unique patients and weighted to estimate all prescriptions and patients in the nation. Finite mixture models were used to estimate different latent patient populations having different patterns of using prescribers. On average, patients in the extreme outlying population (0.7% of purchasers), presumed to be doctor shoppers, obtained 32 opioid prescriptions from 10 different prescribers. They bought 1.9% of all opioid prescriptions, constituting 4% of weighed amounts dispensed.<h4>Conclusions</h4>Our data did not provide information to make a clinical diagnosis of individuals. Very few of these patients can be classified with certainty as diverting drugs for nonmedical purposes. However, even patients with legitimate medical need for opioids who use large numbers of prescribers may signal dangerously uncoordinated care. To close the information gap that makes doctor shopping and uncoordinated care possible, states have created prescription drug monitoring programs to collect records of scheduled drugs dispensed, but the majority of physicians do not access this information. To facilitate use by busy practitioners, most monitoring programs should improve access and response time, scan prescription data to flag suspicious purchasing patterns and alert physicians and pharmacists. Physicians could also prevent doctor shopping by adopting procedures to screen new patients for their risk of abuse and to monitor patients' adherence to prescribed treatments.
format	article
author	Douglas C McDonald Kenneth E Carlson
author_facet	Douglas C McDonald Kenneth E Carlson
author_sort	Douglas C McDonald
title	Estimating the prevalence of opioid diversion by "doctor shoppers" in the United States.
title_short	Estimating the prevalence of opioid diversion by "doctor shoppers" in the United States.
title_full	Estimating the prevalence of opioid diversion by "doctor shoppers" in the United States.
title_fullStr	Estimating the prevalence of opioid diversion by "doctor shoppers" in the United States.
title_full_unstemmed	Estimating the prevalence of opioid diversion by "doctor shoppers" in the United States.
title_sort	estimating the prevalence of opioid diversion by "doctor shoppers" in the united states.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/ed09a7f713ab4b33ad985253145a7dad
work_keys_str_mv	AT douglascmcdonald estimatingtheprevalenceofopioiddiversionbydoctorshoppersintheunitedstates AT kennethecarlson estimatingtheprevalenceofopioiddiversionbydoctorshoppersintheunitedstates
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Estimating the prevalence of opioid diversion by "doctor shoppers" in the United States.

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