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Study Estimates that 4.3 Million Prescriptions for Painkillers Were Diverted to Illicit Use by "Doctor Shoppers"
Date:7/17/2013

CAMBRIDGE, Mass., July 17, 2013 /PRNewswire/ -- Almost one percent of all buyers of addictive pain medications in the U.S. were estimated to be "doctor shoppers" who bought large amounts, presumably for illicit use, according to a study from Abt Associates published today in the journal PLOS ONE.  This is the first national estimate of opioid medications obtained by persons who seek prescriptions for the same drugs from different physicians without telling them about other prescribers. 

One out of every 143 patients who purchased opioid painkillers from retail pharmacies in 2008 received a suspiciously large number of prescriptions from multiple prescribers -- an average of 32 prescriptions from 10 different doctors. 

Although they constituted a small portion of patients prescribed opioids, they purchased an estimated 4.3 million prescriptions, or almost 2 percent of all prescriptions for highly controlled opioids, amounting to about 4 percent of all opioids by weight. 

Abuse of prescription opioids -- commonly known as painkillers -- is linked to rising numbers of overdose deaths and admissions to emergency departments and treatment facilities.  In the absence of adequate patient information systems, individuals can go "doctor shopping" to get excessive quantities of drugs for their own use and abuse as well as for selling to others.  

Researchers Douglas McDonald and Kenneth Carlson of Abt Associates examined a nationwide sample of 146.1 million opioid prescriptions dispensed during 2008 by 76% of U.S. retail pharmacies.

Although getting prescriptions from several different physicians may signal dangerously uncoordinated care rather than fraud, researchers said that most "patients" who get an average of 32 prescriptions from nearly a dozen different doctors in one year are probably deceiving their prescribers rather than receiving badly coordinated care for legitimate medical conditions. 

States have created prescription drug monitoring programs to collect sales records of drugs that pose a high risk of abuse, but many physicians do not access these prescription histories before writing patients' prescriptions.  "Physicians and other healthcare providers are the front lines of defense against deceptive patients who use these drugs for non-medical purposes, but many of them lack the time and the tools to determine if a patient is abusing opioids," said Douglas McDonald, the study's lead author.

The researchers write that physicians could prevent doctor shopping by screening new patients for their risk of abuse and by monitoring patients' adherence to prescribed treatments. Moreover, they recommend that prescription monitoring programs and insurers scan prescription data to flag purchasing patterns indicative of possible doctor shopping and then alert physicians and pharmacists about these patients.   

The study, "Estimating the Prevalence of Opioid Diversion by "Doctor Shoppers" in the United States," was funded by the National Institute on Drug Abuse and is available online at PLOS ONE, http://dx.plos.org/10.1371/journal.pone.0069241

About Abt Associates 
Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators.  The company has multiple offices in the U.S. and program offices in more than 40 countries. www.abtassociates.com


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