Doctor shopping is the practice of obtaining prescription medications, often narcotic painkillers, from multiple physicians. With the rates of pain medication abuse and overdose at alarmingly high levels in recent years, doctor shopping is a major source of concern for physicians and pharmacies everywhere.
The practice of doctor shopping can take many different forms.
Doctor shoppers go from doctor to doctor and pharmacy to pharmacy to get the prescription and medications they want. Because shoppers don’t tell physicians or pharmacists about other prescriptions they’ve had filled, they can potentially end up with a very large amount of prescription medications, either to be used illicitly or to sell illegally.
Often, doctor shopping takes place in emergency rooms or urgent care clinics. Individuals go in complaining of a specific set of symptoms, employing different strategies to avoid being flagged or recognized as a doctor shopper. For example, different names might be used at different locations. Prescriptions might also be paid for with cash, rather than insurance, to make the medications harder to track.
The most common drugs that doctor shoppers seek are prescription pain killers, such as Vicodin and Percocet. These medications are controlled substances, so physicians and pharmacies can’t prescribe and dispense too much per person. Additional drugs that are often sought out by doctor shopping include:
- Muscle relaxants
- Attention deficit hyperactivity disorder (ADHD) medications
The existing monitoring programs for controlled substance drugs are cumbersome and time-consuming even at the state level. Because of this, people who are doctor shopping often don’t even have to go outside their home state or town. It is, however, extremely easy for drug addicts or dealers to cross state borders and obtain prescription medications, since there is no communication between states about drug monitoring.
Doctor shopping is detrimental for everyone, including those who’ve never doctor shopped.
For people who are abusing prescription medications, doctor shopping is associated with serious risks. However, these aren’t the only people who can suffer the effects of doctor shopping. Physicians and pharmacists end up bearing the brunt of the responsibility to put a stop to doctor shopping. Steve Pasierb, president and CEO of The Partnership at Drugfree.org, explains the difficulties physicians experience in an article at Drugs.com:
“Most doctors get no education in medical school about addiction. Their oath is to help this person, but they don’t want to be the inspector general. They are time-challenged and they are loathe to challenge patients.”
One of the big reasons doctors are “loath to challenge patients” is the stigma sometimes felt by people with a genuine need for some of these prescriptions. For example, a person with a real need for narcotic painkillers might feel hesitant about asking for a prescription if a physician challenges him or her about the pain he or she is feeling.
Physicians, pharmacists, and lawmakers are constantly attempting to find ways to reduce the practice of doctor shopping.
Each state has laws in place to reduce the chance of doctor shopping. In Colorado, for instance, physicians are required to perform a physical exam and get a full patient history before prescribing medications. In addition, physicians are required to use tamper-resistant forms, such as prescription pads with watermarks. There are also laws restricting the amount of controlled substance drugs that can be given to patients.
The most reliable way to keep track of doctor shoppers is by using drug monitoring programs. These programs collect information each time a prescription is filled for controlled substance drugs. In theory, this should allow medical practitioners to access individuals’ prescription history to assess their risk of drug abuse. The effectiveness of these programs varies widely, however.
There are also several red flags that physicians and pharmacists watch for. Most obviously, if the same person asks for or fills prescriptions too often, it may begin to look suspicious. During physical exams, physicians may check for signs like needle marks that indicate a drug habit. Urine tests for drugs are also utilized sometimes.
Recent research is identifying more risk factors for doctor shopping and drug abuse. One recent study found that doctor shopping is becoming increasingly prevalent among post-operative patients of orthopaedic trauma and surgery. This suggests that physicians should be mindful about prescribing pain medications to these people without first checking with other overseeing medical practitioners.
Sticking with one main general practitioner is the best way to safely manage a pain condition.
Research has shown that having the same primary care physician (PCP) for a long period of time is highly beneficial. The main reason for this is the relationship that inevitably develops between physician and patient. As the comfort level increases between the physician and patient, the patient is more comfortable sharing any concerns. The physician will come to know the patient very well, so any changing health concerns can be considered alongside a first-hand patient history.
Trust goes hand in hand with this relationship between PCP and patient. Whereas a brand new physician might listen to a patient’s complaint of persistent, inexplicable pain and become immediately concerned that he or she is doctor shopping for painkillers, a PCP will react differently. If the PCP has known the individual for years, perhaps even a decade or more, he or she will know that this person is not prone to complaints, isn’t a fan of medication in general, and would never ask for a prescription painkiller unless it was serious.
After the PCP has provided his or her patient with whatever medications are needed for comfort, he or she can then make referrals to specialists for further treatment. Generally, referrals are hard to come by unless there’s at least some basic relationship between the physician and patient, and a referral is crucial. Without a referral, seeing a specialist might be difficult or impossible. Additionally, many insurance companies won’t pay for specialists without a referral from a PCP.
However, simply having more than one physician does not constitute doctor shopping.
Almost any chronic medical condition will require a team of medical professionals. The PCP should be the go-to physician who coordinates all specialist referrals, but the rest of the team might include pain specialists, cardiologists, pulmonologists, surgeons, nutritionists, therapists, or any number of other specialists. As long as all the medical professionals on the team are aware of the medications prescribed by the others, this is entirely safe.
Do you have a PCP who helps you oversee your medical care?
Image by Dave Fulmer via Flickr