A Mixed-Method Analysis of Reports on 100 Cases of Improper Prescribing of Controlled Substances

Abstract

Improper prescribing of controlled substances contributes to opioid addictions and deaths by overdose. Studies conducted to-date have largely lacked a theoretical framework and ignored the interaction of individual with environmental factors. We conducted a mixed-method analysis of published reports on 100 cases that occurred in the United States. An average of 17 reports (e.g., from medical boards) per case were coded for 38 dichotomous variables describing the physician, setting, patients, and investigation. A theory on how the case occurred was developed for each case. Explanatory typologies were developed and then validated through hierarchical cluster analysis. Most cases involved physicians who were male (88%), >40 years old (90%), non-board certified (63%), and in small private practices (97%); 54% of cases reported facts about the physician indicative of self-centered personality traits. Three explanatory typologies were validated. Increasing oversight provided by peers and trainees may help prevent improper prescribing of controlled substances.

Exploring unnecessary invasive procedures in the United States: a retrospective mixed-methods analysis of cases from 2008-2016

“…We coded in two rounds. Most variables were deductive in that they were based on our systematic literature reviews and past research projects on cases of professional breaches [ 14 , 15 , 34 , 35 ]. However, some variables—such as specific fraud charges, relationships to industry, and the dollar amounts billed—were inductive, arising from the process of coding the cases.…”

“…The study reported in this paper is part of a larger project to understand causal factors associated with significant professional breaches in medicine such as running an opioid “pill mill,” [ 14 ] inappropriately touching patients during exams, [ 15 ] and performing unnecessary surgeries for profit. We have focused on high-profile cases of professional breaches that directly cause significant harm to patients.…”

“…Previous work by our team found that such work is feasible for three reasons. First, large convenience samples of cases can be obtained by culling publicly available records from medical boards and court cases; second, a wide variety of variables can be reliably coded to generate rich descriptions of cases and causal theories; and third, the MMO framework provides a useful theoretical lens for analyzing the complex causal factors that contribute to the occurrence of serious professional breaches [ 14 , 15 , 33 ]. The present study applied this approach to the study of invasive procedures such as stents or surgeries that were deemed unnecessary by medical boards, courts, or federal prosecutors.…”

Between a Rock and a Hard Place: Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanction?

“…50 Current work by DuBois and colleagues on misprescribing of controlled substances (primarily opioids) found similar patterns. 51 Rather than studying physician demographics, Rich and Webster looked at underlying behavior patterns by analyzing medical records in malpractice opioid overdose cases from 2005 to 2009. 52 They attributed the cause of overdose to physician error in seventy-five percent of the cases.…”

How broad are state physician health program descriptions of physician impairment?

“…There is very little evidence to suggest, however, that mental disorders in physicians are a meaningful cause of medical errors or preventable adverse events [ 4 , 5 ]. On the basis of empirical research, male sex appears to be a better predictor of poor performance or subsequent professional discipline than the presence of a mental disorder [ 6 – 12 ]. Therefore, it is not entirely clear why these policies have persisted and continue to encourage more referrals to PHPs.…”