Prescription Drug Monitoring Program Data: Identification of “Doctor Shoppers”

BACKGROUND: In the last 20 years, the use of opioid analgesics in pain management has increased 10-fold (Okie, 2010; Paone et al., 2011).  Concurrently, overdose deaths involving opioid analgesics have surpassed overdose deaths involving heroin and cocaine combined (MMWR, 2011).  Similarly, while overdose deaths decreased 36% from 2005 to 2010 in NYC, deaths involving opioid analgesics increased 30% during the same time period (NYCDOMH, 2011).

The objectives of this presentation are 1) to identify and describe characteristics of “doctor shoppers” - the practice of obtaining controlled substances (opioid analgesics) from multiple health care practitioners without the prescribers’ knowledge of the other prescriptions- an indicator of opioid prescription misuse and; 2) to identify predictors of increased risk for “doctor shopping”. 

METHODS: “Doctor Shoppers” were defined as patients who filled 3-or more prescriptions written by 3-different prescribers at 3-or more pharmacies within a 3-month period.

 We conducted a retrospective review of 2010 data from the New York State Prescription Drug Monitoring Program. The sample included all NYC residents who filled prescriptions for Schedule II opioid analgesics and hydrocodone during 2010 (N=722,621).  Of those, 144,524 (20%) filled 3 or more prescriptions and were included in the final analytic sample.  Independent variables included socio-demographics, type of opioid analgesic, day supply, and morphine equivalent dose. A series of binomial logistic regressions will be performed to determine predictors of doctor-shopping and calculate odds ratios.

 

RESULTS: Less than 20,000 patients (N=17,795) or 2.5% of our analytic sample were defined as doctor shoppers. The rate was highest among the group aged 45-54 (65/1000,000), nearly double the rate of all other age groups except the 35-45 year olds (45/1000,000) and the group aged 55-64 (39/100,000).  While only 16% of non-doctor shoppers paid in cash, 48% of doctor shoppers did. Four out of ten doctor shoppers filled a script for 100 or more morphine equivalents, while only 6% of non-doctor shoppers did so. Median day supply was 30 among doctor shoppers, double that of non-doctor shoppers. Staten Island had the highest rate (569/100,000) per capita of doctor shoppers, more than double that of all other boroughs; the opioid analgesic mortality rate is also double in Staten Island compared with all other boroughs.

 

CONCLUSIONS:  Identifying and describing the profiles of doctor shoppers and associated predictors, presents opportunities to intervene and to reduce the risk of opioid analgesic related fatalities.