Early Detection of Prescription Drug Abuse Using Doctor Shopping Monitoring From Claims Databases: Illustration From the Experience of the French Addictovigilance Network

Abstract

Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence. Awareness of prescription drug abuse has been increasing in the last two decades, and organizations such as the International Narcotics Control Board has predicted that, worldwide, prescription drug abuse may exceed the use of illicit drugs. Assessment of prescription drug abuse tackles an issue that is hidden by nature, which therefore requires a specific monitoring. The current best practice is to use multiple detection systems to assess prescription drug abuse by various populations in a timely, sensitive, and specific manner. In the early 2000's, we designed a method to detect and quantify doctor shopping for prescription drugs from the French National Health Data System, which is one of the world's largest claims database, and a first-class data source for pharmacoepidemiological studies. Doctor shopping is a well-known behavior that involves overlapping prescriptions from multiple prescribers for the same drug, to obtain higher doses than those prescribed by each prescriber on an individual basis. In addition, doctor shopping may play an important role in supplying the black market. The paper aims to review how doctor shopping monitoring can improve the early detection of prescription drug abuse within a multidimensional monitoring. The paper provides an in-depth overview of two decades of development and validation of the method as a complementary component of the multidimensional monitoring conducted by the French Addictovigilance Network. The process accounted for the relevant determinants of prescription drug abuse, such as pharmacological data (e.g., formulations and doses), chronological and geographical data (e.g., impact of measures and comparison between regions), and epidemiological and outcome data (e.g., profiles of patients and trajectories of care) for several pharmacological classes (e.g., opioids, benzodiazepines, antidepressants, and methylphenidate).

Increase of high‐risk tramadol use and harmful consequences in France from 2013 to 2018: Evidence from the triangulation of addictovigilance data

“…In France, illegal ways of tramadol procurement were evidenced through addictovigilance, mainly with increased doctor shopping, pharmacy hopping and forged prescriptions. According to the analysis performed in national databases, from 2010 to 2016, tramadol was one of the few opioids for which both the quantity and the proportion obtained by doctor shopping increased 50,51 …”

“…According to the analysis performed in national databases, from 2010 to 2016, tramadol was one of the few opioids for which both the quantity and the proportion obtained by doctor shopping increased. 50,51 4.2 | Tramadol-related fatalities according to the profiles of the users…”

Understanding the diagnoses and medical care experience of patients with new daily persistent headache: a qualitative study in Spain

“…In relation to visiting multiple physicians in search of a diagnosis, the participants may have presented a behaviour known as ‘doctor shopping’. 47 48 This term refers to the behaviour of patients characterised by the pilgrimage from one doctor to another, with the aim of obtaining drug prescriptions (addiction), 49 to be diagnosed with a certain disease, or because of dissatisfaction with the professional care received. 47 Certainly, based on their narratives, our participants present characteristics that are compatible with doctor-shoppers, such as presenting intense pain, treatment including analgesic opioids and other coadjuvant drugs, as well as dissatisfaction with medical care.…”

Prevention of risks associated with inappropriate use/unnecessary consumption of medicines

“… Mésange Project: identification of cases of misuse at the time of pharmaceutical dispensing Companies Escalation of signals to National Agency for the Safety of Medicines and Health Products Indicators for monitoring of sales, indicators for medical information questions Doctors and (dispensing) chemists Structuring of shared medical record (universal access), and harmonisation with the pharmaceutical file Hospitals Monitoring of consumption, monitoring of supply tensions National Agency for the Safety of Medicines and Health Products Comparison of the number of average packs with respect to the expected number, for abuse and for non-MA prescriptions/dispenses. Highlighting of misuse via health insurance databases [21] Detection of doctor-shopping behaviour [22] Patients On an individual basis: Medicine conciliation; use by the doctor of tools for highlighting misuse (e.g. opioids) Treatment National Agency for the Safety of Medicines and Health Products Change of prescription methods (health authorities), risk reduction measures (Agencies, commercial documents e.g.…”