Doctor hopping and doctor shopping for prescription opioids associated with increased odds of high‐risk use

Young, S. Y.; Hayes, Corey J.; Aram, Jonathan; Tait, Mark

doi:10.1002/pds.4838

Cited by 16 publications

(10 citation statements)

References 24 publications

(44 reference statements)

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“…The number of prescribing physicians can be a further indicator for potential abusive OA intake (Young et al, 2019). In the present study a higher number of prescribing physicians was found among long-term users with daily doses of more than one DDD in 2015.…”

Section: Discussionsupporting

confidence: 46%

Trends in risky prescriptions of opioid analgesics from 2011 to 2015 in Northern Germany

et al. 2020

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Introduction: Due to their euphoric and sedative effects, opioid analgesics have high potential for abuse and dependence. In the last decade in the USA and many Western European Countries the prescription rates of opioid analgesics have steadily increased. Objective: This study describes 5-year trends in the prescription of opioid analgesics and risk indicators such as duration, dose and ‘doctor shopping’ in Northern Germany. Methods: The annual rates of opioid analgesic prescriptions have been analysed for patients with statutory health insurance processed by the North German Pharmacy Data Center for the years 2011–2015. A distinction was made between non-cancer patients and cancer patients, and different groups according to prescription duration and dose level. Results: Between 2011 and 2015, the annual number of patients with opioid analgesic prescriptions increased from 500,000 to 550,000. About half of non-cancer-patients (85% of the total sample) and cancer patients received opioid analgesics for 90 days or less. The rates for long-term prescriptions (⩾9 months) ranged between 6–7% for non-cancer patients and 7–8% for cancer patients. Between 1.2–1.8% received opioid analgesics in doses of more than two defined daily doses. The majority of non-cancer patients with opioid analgesic prescriptions were female. The average age of non-cancer patients was 66 years. About 80% of non-cancer patients with first opioid analgesic prescription received World Health Organization step II medication. Conclusion: For the first time, this study provides comprehensive patient-related analyses of opioid analgesic prescriptions in Germany over a 5-year period. Despite a slight increase in the overall number of opioid analgesic prescriptions, an epidemic spread of opioid analgesics cannot be observed.

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Section: Discussionsupporting

confidence: 46%

Trends in risky prescriptions of opioid analgesics from 2011 to 2015 in Northern Germany

et al. 2020

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“…“Doctor-shopping” for the prescription of opioids has been associated with greater odds of high-risk use, and these patients may schedule excessive follow-up appointments. 30 Alternatively, it might represent patients with uncontrolled postoperative pain, for whom salvage procedures for failed thumb BJA should be considered.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Opioid Use Results in Greater Postoperative Opioid Consumption After Thumb Basal Joint Arthroplasty

Adams

Paladino

Townsend

et al. 2022

Journal of Hand Surgery Global Online

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Purpose: Thumb basal joint arthroplasty surgery is a common hand surgery after which patients often require opioids. To better understand safe opioid consumption patterns, this study sought to identify risk factors for filling a second prescription and/or prolonged opioid use (prescription over 6 months after the surgery). Preoperative opioid use was hypothesized to show an association with greater postoperative opioid use. Methods: A retrospective review of consecutive patients who underwent primary thumb basal joint arthroplasty was conducted, yielding 110 patients for analysis. Demographic and clinical data were collected. Opioid prescription data were extracted from 6 months before the surgery to 9 months after the surgery using a state prescription drug monitoring program. Bivariate and multivariate analyses were performed for filling a second opioid prescription or filling an opioid prescription over 6 months after the surgery. Results: All the patients filled their initial postoperative prescription. Of the 110 patients, 26.4% filled an opioid prescription before the surgery, 42% filled a second postoperative prescription, and 14.5% were still consuming opioids over 6 months after the surgery. Patients using preoperative opioids had 7-fold higher odds of filling a second opioid prescription and 37-fold higher odds of prolonged use. No other demographic or clinical factors, including the type of procedure or number of initial opioids prescribed, were associated with increased use of postoperative opioids. Of all the opioid prescriptions filled after the initial postoperative prescription, only 9.3% were prescribed by a surgeon's office. Conclusions: Patients who undergo thumb basal joint arthroplasty with preoperative opioid use have much greater odds of filling a second opioid prescription and prolonged use after the surgery. Low initial surgeon-provided opioid dosages did not correlate to filling a second prescription, indicating that lower initial doses are feasible. Finally, nearly all opioid-naïve patients who filled a second opioid prescription received them from providers other than a surgeon, indicating the need for greater communication with nonsurgical providers simultaneously caring for patients in the perioperative period. Type of study/level of evidence: Therapeutic III.

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“… 10 A recent study examining opioid prescriptions found that COP individuals in Arkansas had higher odds of engaging in high-risk opioid use. 11 …”

Section: Introductionmentioning

confidence: 99%

Assessing the Impact of Indiana Public Law 194 on Curbing the Concurrent Opioid Prescribing for Indiana Medicaid Enrollees

et al. 2023

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Background: Several US states have introduced legislation to support the legitimate medical use of opioids while limiting misuse and diversion. One concern which has been addressed through legislation is preventing individuals from seeking opioid prescriptions concurrently from multiple providers. However, the impact of this legislation on the incidence of patients receiving concurrent prescriptions remains relatively unexplored. This study examines this phenomenon based on claims data from Medicaid enrollees and the enactment of legislation in Indiana. Methods: Indiana Medicaid claims data over the period of January 2014 to December 2019 were used to determine the changes in the percentage of individuals receiving opioid prescriptions from multiple providers within a 30-day period, that is, concurrent opioid prescription (COP) individuals. Indiana Medicaid enrollees with a diagnosis of opioid use disorder (OUD) receiving opioid prescriptions, that is, the OUD-group, were identified and separated from the enrollees without a diagnosis but receiving opioid prescriptions, that is, the non-OUD group. The mean percentages of COP individuals (with or without an OUD diagnosis) within the subset of individuals that received opioid prescriptions were compared before and after the passage of Indiana Public Law 194. Results: There were 5336 who met the criteria of COP individuals, and 2050 of those were in the OUD-group. In either group, there was a significant difference in the change in percentages (slope) before and after Indiana Public Law 194 passed. In addition, there was a significant decrease in the mean percentage of COP individuals in the non-OUD group, while the difference was not significant in the OUD group. Conclusion: Our study suggests that Indiana Public Law 194 had a positive impact on curbing COP. This study is limited by the level of details available from claims data and suggests additional studies to evaluate prescription use and prescribing practices are warranted.

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Doctor hopping and doctor shopping for prescription opioids associated with increased odds of high‐risk use

Cited by 16 publications

References 24 publications

Trends in risky prescriptions of opioid analgesics from 2011 to 2015 in Northern Germany

Trends in risky prescriptions of opioid analgesics from 2011 to 2015 in Northern Germany

Preoperative Opioid Use Results in Greater Postoperative Opioid Consumption After Thumb Basal Joint Arthroplasty

Assessing the Impact of Indiana Public Law 194 on Curbing the Concurrent Opioid Prescribing for Indiana Medicaid Enrollees

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