'Doctor Shopping': Data from California's prescription monitoring program

Feb 5 2010

Research presented at the American Academy of Pain Medicine's 26th Annual Meeting provides early published data analyzing information gathered from California's prescription monitoring program, known as the Controlled Substances Utilization Review and Evaluation System (CURES). The analysis found a two-fold increase in the likelihood of individuals receiving opioids from multiple providers or "doctor shopping" when they were also being simultaneously prescribed a single additional class of a controlled substances, such as benzodiazepines or amphetamines. When there was more than one additional drug class involved, there was a 13-fold increase for individuals seeing multiple providers.

Over 34 states (stat from the DEA, link below) currently have prescription monitoring programs in place in an effort to address prescription drug abuse, addiction and diversion. One goal of the PMPs is to prevent individuals from "doctor shopping" where they obtain multiple prescriptions from multiple healthcare providers, which they subsequently fill at multiple pharmacies. To date, there is limited published data demonstrating the frequency of multiple provider episodes for controlled substances.  

Analyzing de-identified prescription data from the CURES program, researchers at the University of California, Davis found that approximately half of the multiple provider episodes or "doctor shopping" cases involved more than one occurrence. Researchers also report that approximately 13% of these occurrences involved prescriptions for opioid prescriptions, followed by 4% for benzodiazepines, followed by stimulant amphetamines (1.4%) and diet amphetamines (0.8%)

Lead researcher and AAPM Director at Large, Past President (2005), and AAPM Chair of Legislative and Regulatory Affairs, Scott Fishman MD, comments, "These preliminary data suggest that multiple prescribing of controlled substances is a real problem. The AAPM has long advocated for PMPs that make useful data available to prescribers at the point of care so they can help mitigate this problem. As our regulators and legislators seek solutions for minimizing prescription drug abuse, this study should help elucidate the value of PMPs that partner with clinicians in appropriate monitoring."

The data also showed that the greatest association with multiple provider episodes occurred when an individual was simultaneously receiving prescriptions for different classes of controlled substances, while using multiple prescribers to obtain other controlled substances. Individuals who obtained opioids from multiple providers were 10 to 21-fold more likely, respectively, to also receive benzodiazepines or amphetamines from multiple practitioners. Similar results were obtained with benzodiazepines and amphetamines.

The study also found that individuals "doctor shopping" for opioids were younger and resided in larger metropolitan areas.