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Sahebi-Fakhrabad A, Sadeghi AH, Kemahlioglu-Ziya E, Handfield R, Tohidi H, Vasheghani-Farahani I. The Impact of Opioid Prescribing Limits on Drug Usage in South Carolina: A Novel Geospatial and Time Series Data Analysis. Healthcare (Basel) 2023; 11:healthcare11081132. [PMID: 37107966 PMCID: PMC10137799 DOI: 10.3390/healthcare11081132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The opioid crisis in the United States has had devastating effects on communities across the country, leading many states to pass legislation that limits the prescription of opioid medications in an effort to reduce the number of overdose deaths. This study investigates the impact of South Carolina's prescription limit law (S.C. Code Ann. 44-53-360), which aims to reduce opioid overdose deaths, on opioid prescription rates. The study utilizes South Carolina Reporting and Identification Prescription Tracking System (SCRIPTS) data and proposes a distance classification system to group records based on proximity and evaluates prescription volumes in each distance class. Prescription volumes were found to be highest in classes with pharmacies located further away from the patient. An Interrupted Time Series (ITS) model is utilized to assess the policy impact, with benzodiazepine prescriptions as a control group. The ITS models indicate an overall decrease in prescription volume, but with varying impacts across the different distance classes. While the policy effectively reduced opioid prescription volumes overall, an unintended consequence was observed as prescription volume increased in areas where prescribers were located at far distances from patients, highlighting the limitations of state-level policies on doctors. These findings contribute to the understanding of the effects of prescription limit laws on opioid prescription rates and the importance of considering location and distance in policy design and implementation.
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Affiliation(s)
- Amirreza Sahebi-Fakhrabad
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
| | - Amir Hossein Sadeghi
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
| | - Eda Kemahlioglu-Ziya
- Department of Business Management, Poole College of Management, North Carolina State University, Raleigh, NC 27695, USA
| | - Robert Handfield
- Department of Business Management, Poole College of Management, North Carolina State University, Raleigh, NC 27695, USA
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Sahebi-Fakhrabad A, Sadeghi AH, Handfield R. Evaluating State-Level Prescription Drug Monitoring Program (PDMP) and Pill Mill Effects on Opioid Consumption in Pharmaceutical Supply Chain. Healthcare (Basel) 2023; 11:437. [PMID: 36767012 PMCID: PMC9914561 DOI: 10.3390/healthcare11030437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
The opioid crisis in the United States has had devastating effects on communities across the country, leading many states to pass legislation that limits the prescription of opioid medications in an effort to reduce the number of overdose deaths. This study evaluates the impact of two categories of PDMP and Pill Mill regulations on the supply of opioid prescriptions at the level of dispensers and distributors (excluding manufacturers) using ARCOS data. The study uses a difference-in-difference method with a two-way fixed design to analyze the data. The study finds that both of the regulations are associated with reductions in the volume of opioid distribution. However, the study reveals that these regulations may have unintended consequences, such as shifting the distribution of controlled substances to neighboring states. For example, in Tennessee, the implementation of Operational PDMP regulations reduces the in-state distribution of opioid drugs by 3.36% (95% CI, 2.37 to 4.3), while the out-of-state distribution to Georgia, which did not have effective PDMP regulations in place, increases by 16.93% (95% CI, 16.42 to 17.44). Our studies emphasize that policymakers should consider the potential for unintended distribution shifts of opioid drugs to neighboring states with laxer regulations as well as varying impacts on different dispenser types.
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Affiliation(s)
- Amirreza Sahebi-Fakhrabad
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
- Department of Business Management, Poole College of Management, North Carolina State University, 2806-A Hillsborough St. Building 217, Raleigh, NC 27695, USA
| | - Amir Hossein Sadeghi
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27606, USA
| | - Robert Handfield
- Department of Business Management, Poole College of Management, North Carolina State University, 2806-A Hillsborough St. Building 217, Raleigh, NC 27695, USA
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3
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Effects of ‘doctor shopping’ behaviour on prescription of addictive drugs in Sweden. Soc Sci Med 2022; 296:114739. [DOI: 10.1016/j.socscimed.2022.114739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/18/2021] [Accepted: 01/19/2022] [Indexed: 11/21/2022]
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Maeda K, Shigemura K, Yang Y, Nakano Y, Arakawa S, Fujisawa M. A case of refractory urethritis with repeated doctor shopping. IJU Case Rep 2022; 5:129-131. [PMID: 35252799 PMCID: PMC8888020 DOI: 10.1002/iju5.12415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In the field of sexually transmitted diseases, resistance and diversification of causative organisms are becoming a problem. We report a case in which the course of the disease was complicated by doctor shopping. CASE PRESENTATION A man in his 40s visited his local doctor for painful urination and cloudy urine. Due to the lack of improvement in symptoms after antibiotic treatment, he self-selected to visit six hospitals in just five months. He visited our clinic only a few times and then stopped coming. CONCLUSION Doctor shopping, as well as self-diagnosis and self-treatment, will continue to increase. Patient education is important, but medical professionals also need to be aware of the possibility of doctor shopping when treating patients.
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Affiliation(s)
- Koki Maeda
- Department of UrologyKobe University Graduate School of MedicineKobeJapan
| | - Katsumi Shigemura
- Department of UrologyKobe University Graduate School of MedicineKobeJapan
| | - Yong‐Ming Yang
- Department of UrologyKobe University Graduate School of MedicineKobeJapan
| | - Yuzo Nakano
- Department of UrologyKobe University Graduate School of MedicineKobeJapan
| | | | - Masato Fujisawa
- Department of UrologyKobe University Graduate School of MedicineKobeJapan
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Perry BL, Odabaş M, Yang KC, Lee B, Kaminski P, Aronson B, Ahn YY, Oser CB, Freeman PR, Talbert JC. New means, new measures: assessing prescription drug-seeking indicators over 10 years of the opioid epidemic. Addiction 2022; 117:195-204. [PMID: 34227707 PMCID: PMC8664959 DOI: 10.1111/add.15635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/02/2020] [Accepted: 06/23/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Prescription drug-seeking (PDS) from multiple prescribers is a primary means of obtaining prescription opioids; however, PDS behavior has probably evolved in response to policy shifts, and there is little agreement about how to operationalize it. We systematically compared the performance of traditional and novel PDS indicators. DESIGN Longitudinal study using a de-identified commercial claims database. SETTING United States, 2009-18. PARTICIPANTS A total of 318 million provider visits from 21.5 million opioid-prescribed patients. MEASUREMENTS We applied binary classification and generalized linear models to compare predictive accuracy and average marginal effect size predicting future opioid use disorder (OUD), overdose and high morphine milligram equivalents (MME). We compared traditional indicators of PDS to a network centrality measure, PageRank, that reflects the prominence of patients in a co-prescribing network. Analyses used the same data and adjusted for patient demographics, region, SES, diagnoses and health services. FINDINGS The predictive accuracy of a widely used traditional measure (N + unique doctors and N + unique pharmacies in 90 days) on OUD, overdose and MME decreased between 2009 and 2018, and performed no better than chance (50% accuracy) after 2015. Binarized PageRank measures however exhibited higher predictive accuracy than the traditional binary measures throughout 2009-2018. Continuous indicators of PDS performed better than binary thresholds, with days of Rx performing best overall with 77-93% predictive accuracy. For example, days of Rx had the highest average marginal effects on overdose and OUD: a 1 standard deviation increase in days of Rx was associated with a 6-8% [confidence intervals (CIs) = 0.058-0.061 and 0.078-0.082] increase in the probability of overdose and a 4-5% (CIs = 0.038-0.043 and 0.047-0.053) increase in the probability of OUD. PageRank performed nearly as well or better than traditional indicators of PDS, with predictive performance increasing after 2016. CONCLUSIONS In the United States, network-based measures appear to have increasing promise for identifying prescription opioid drug-seeking behavior, while indicators based on quantity of providers or pharmacies appear to have decreasing utility.
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Affiliation(s)
- Brea L. Perry
- Network Science Institute, Indiana University, 1001 45/46 Bypass, Bloomington, IN, United States of America,Department of Sociology, Indiana University, Bloomington, IN, United States of America
| | - Meltem Odabaş
- Department of Sociology, Indiana University, Bloomington, IN, United States of America
| | - Kai-Cheng Yang
- School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States of America
| | - Byungkyu Lee
- Department of Sociology, Indiana University, Bloomington, IN, United States of America
| | - Patrick Kaminski
- Department of Sociology, Indiana University, Bloomington, IN, United States of America,School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States of America
| | - Brian Aronson
- Department of Sociology, Indiana University, Bloomington, IN, United States of America
| | - Yong-Yeol Ahn
- Network Science Institute, Indiana University, 1001 45/46 Bypass, Bloomington, IN, United States of America,School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States of America
| | - Carrie B. Oser
- Department of Sociology, University of Kentucky, Lexington, KY, United States of America
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States of America
| | - Jeffrey C. Talbert
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States of America
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6
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Delcher C, Bae J, Wang Y, Doung M, Fink DS, Young HW. Defining "Doctor shopping" with Dispensing Data: A Scoping Review. PAIN MEDICINE 2021; 23:1323-1332. [PMID: 34931686 DOI: 10.1093/pm/pnab344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND "Doctor shopping" typically refers to patients that seek controlled substance prescriptions from multiple providers with the presumed intent to obtain these medications for non-medical use and/or diversion. The purpose of this scoping review is to document and examine the criteria used to identify "doctor shopping" from dispensing data in the United States. METHODS A scoping review was conducted on "doctor shopping" or analogous terminology from January 1, 2000 through December 31, 2020 using the Web of Science Core Collection (7 citation indices). Our search was limited to U.S. only, English-language, peer-reviewed and U.S. federal government studies. Studies without explicit "doctor shopping" criteria were excluded. Key components of these criteria included the number of prescribers and dispensers, dispensing period, and drug class (e.g., opioids). RESULTS Of 9,845 records identified, 95 articles met the inclusion criteria and our pool of studies ranged from years 2003 to 2020. The most common threshold-based or count definition was [≥4 Prescribers (P) AND ≥4 Dispensers (D)] (n = 12). Thirty-three studies used a 365-day detection window. Opioids alone were studied most commonly (n = 69), followed by benzodiazepines and stimulants (n = 5 and n = 2, respectively). Only 39 (41%) studies provided specific drug lists with active ingredients. CONCLUSION Relatively simple P × D criteria for identifying "doctor shopping" are still the dominant paradigm with the need for on-going validation. The value of P × D criteria may change through time with more diverse methods applied to dispensing data emerging.
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Affiliation(s)
- Chris Delcher
- Institute for Pharmaceutical Outcomes & Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Jungjun Bae
- Institute for Pharmaceutical Outcomes & Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Yanning Wang
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Michelle Doung
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - David S Fink
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York, USA
| | - Henry W Young
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
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7
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Canseco JA, Chang M, Karamian BA, Mao JZ, Reyes AA, Mangan J, Divi SN, Goyal DKC, Salmons HI, Dohse N, Levy N, Detweiler M, Anderson DG, Rihn JA, Kurd MF, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Predictors of Prolonged Opioid Use After Lumbar Fusion and the Effects of Opioid Use on Patient-Reported Outcome Measures. Global Spine J 2021; 13:21925682211041968. [PMID: 34488470 PMCID: PMC10448099 DOI: 10.1177/21925682211041968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To determine risk factors associated with prolonged opioid use after lumbar fusion and to elucidate the effect of opioid use on patient-reported outcome measures (PROMs) after surgery. METHODS Patients who underwent 1-3 level lumbar decompression and fusion with at least one-year follow-up were identified. Opioid data were collected through the Pennsylvania Prescription Drug Monitoring Program. Preoperative "chronic use" was defined as consumption of >90 days in the one-year before surgery. Postoperative "prolonged use" was defined as a filled prescription 90-days after surgery. PROMs included the following: Short Form-12 Health Survey PCS-12 and MCS-12, ODI, and VAS-Back and Leg scores. Logistic regression was performed to determine independent predictors for prolonged opioid use. RESULTS The final analysis included 260 patients. BMI >35 (OR: .44 [.20, .90], P = .03) and current smoking status (OR: 2.73 [1.14, 6.96], P = .03) significantly predicted postoperative opioid usage. Chronic opioid use before surgery was associated with greater improvements in MCS-12 (β= 5.26 [1.01, 9.56], P = .02). Patients with prolonged opioid use self-reported worse VAS-Back (3.4 vs 2.1, P = .003) and VAS-Leg (2.6 vs 1.2, P = .03) scores after surgery. Prolonged opioid use was associated with decreased improvement in VAS-Leg over time (β = .14 [.15, 1.85], P = .02). CONCLUSIONS Current smoking status and lower BMI were significantly predictive of prolonged opioid use. Excess opioid use before and after surgery significantly affected PROMs after lumbar fusion.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Chang
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A Karamian
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer Z Mao
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Ariana A Reyes
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - John Mangan
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Srikanth N Divi
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Dhruv KC Goyal
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Harold I Salmons
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicolas Dohse
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Noah Levy
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Maxwell Detweiler
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - D Greg Anderson
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey A Rihn
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark F Kurd
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K Kepler
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
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8
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Zhang V(S, King MD. Tie Decay and Dissolution: Contentious Prescribing Practices in the Prescription Drug Epidemic. ORGANIZATION SCIENCE 2021; 32:1149-1173. [DOI: 10.1287/orsc.2020.1412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although a substantial body of work has investigated drivers of tie formation, there is growing interest in understanding why relationships decay or dissolve altogether. The networks literature has tended to conceptualize tie decay as driven by processes similar to those underlying tie formation. Yet information that is revealed through ongoing interactions can exert different effects on tie formation and tie decay. This paper investigates how tie decay and tie formation processes differ by focusing on contentious practices. To the extent that information about dissimilarities in contentious practices is learned through ongoing interactions, it can exert diverging effects on tie formation and tie decay. Using a longitudinal data set of 141,543 physician dyads, we find that differences in contentious prescribing led ties to weaken or dissolve altogether but did not affect tie formation. The more contentious the practice and the more information available about the practice, the stronger the effect on tie decay and dissolution. Collectively, these findings contribute to a more nuanced understanding of relationship evolution as an unfolding process through which deeper-level differences are revealed and shape the outcome of the tie.
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Affiliation(s)
| | - Marissa D. King
- Yale School of Management, Yale University, New Haven, Connecticut 06511
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9
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Kruse CS, Kindred B, Brar S, Gutierrez G, Cormier K. Health Information Technology and Doctor Shopping: A Systematic Review. Healthcare (Basel) 2020; 8:E306. [PMID: 32872211 PMCID: PMC7551569 DOI: 10.3390/healthcare8030306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 01/13/2023] Open
Abstract
Doctor shopping is the practice of visiting multiple physicians to obtain multiple prescriptions. Health information technology (HIT) allows healthcare providers and patients to leverage records or shared information to improve effective care. Our research objective was to determine how HIT is being leveraged to control for doctor shopping. We analyzed articles that covered a 10-year time period from four databases and reported using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We compared intervention, study design, and bias, in addition to showing intervention interactions with facilitators, barriers, and medical outcomes. From 42 articles published from six countries, we identified seven interventions, five facilitator themes with two individual observations, three barrier themes with six individual observations, and two medical outcome themes with four individual observations. Multiple HIT mechanisms exist to control for doctor shopping. Some are associated with a decrease in overdose mortality, but access is not universal or compulsory, and data sharing is sporadic. Because shoppers travel hundreds of miles in pursuit of prescription drugs, data sharing should be an imperative. Research supports leveraging HIT to control doctor shopping, yet without robust data sharing agreements, the efforts of the system are limited to the efforts of the entity with the least number of barriers to their goal. Shoppers will seek out and exploit that organization that does not require participation or checking of prescription drug monitoring programs (PDMP), and the research shows that they will drive great distances to exploit this weakest link.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX 78666, USA; (B.K.); (S.B.); (G.G.); (K.C.)
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10
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Duvallet C, Hayes BD, Erickson TB, Chai PR, Matus M. Mapping Community Opioid Exposure Through Wastewater-Based Epidemiology as a Means to Engage Pharmacies in Harm Reduction Efforts. Prev Chronic Dis 2020; 17:E91. [PMID: 32816660 PMCID: PMC7466868 DOI: 10.5888/pcd17.200053] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Bryan D Hayes
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Timothy B Erickson
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Medical Toxicology, Department of Emergency Medicine, Brigham Health, Boston, Massachusetts.,Harvard Humanitarian Institute, Boston, Massachusetts
| | - Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham Health, Boston, Massachusetts.,The Fenway Institute, Boston, Massachusetts.,The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Mariana Matus
- Biobot Analytics, Inc, 501 Massachusetts Ave, Cambridge, MA 02139.
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11
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Stephenson JJ, Cepeda MS, Zhang J, Dinh J, Hall K, Esposito DB, Kern DM. The Association Between Doctor and Pharmacy Shopping and Self-Reported Misuse and Abuse of Prescription Opioids: A Survey Study. J Pain Res 2020; 13:689-701. [PMID: 32308468 PMCID: PMC7140905 DOI: 10.2147/jpr.s232409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/19/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/RATIONALE Little is known about the reasons for visiting multiple doctors/pharmacies, known as doctor/pharmacy shopping, to obtain opioids. OBJECTIVE To investigate patients' self-reported reasons for doctor/pharmacy shopping and assess whether doctor/pharmacy shopping behavior can be used as a surrogate measure of opioid abuse/misuse. METHODS We conducted a cross-sectional web-based survey among adult patients with ≥2 pharmacy claims for immediate-release or extended-release/long-acting opioids between 7/1/2015 and 12/31/2016, identified from a large United States (US) commercial claims database. Patients were classified into no, mild, moderate, or severe shopping categories based on their claims. Reasons for doctor/pharmacy shopping and opioid abuse/misuse were determined from patient responses to the Prescription Opioid Misuse and Abuse Questionnaire. RESULTS A random sample of 10,081 patients was invited to participate in the survey and 1085 (11%) completed surveys. The most frequently reported reasons for doctor/pharmacy shopping were convenience, availability, price, and multiple morbidities requiring pain management. Among patients in the no, minimal, moderate, and severe shopping categories, only 7.8%, 8.5%, 11.8% and 12.6% reported opioid abuse/misuse, respectively. CONCLUSION In this commercially-insured population, patient-reported reasons for doctor/pharmacy shopping do not suggest opioid abuse/misuse. Less than 15% of patients with shopping behavior in the past 3 months reported any reasons attributable to opioid abuse/misuse, indicating that shopping behavior in this population may not be a good surrogate for abuse/misuse.
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Affiliation(s)
| | - M Soledad Cepeda
- Epidemiology, Janssen Research and Development, Titusville, NJ, USA
| | - Jie Zhang
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
- Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA
| | - Jade Dinh
- Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA
| | - Kelsey Hall
- Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA
| | - Daina B Esposito
- Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA
- Ciconia, Inc, Westford, MA, USA
- Epidemiology, Boston University, Boston, MA, USA
| | - David M Kern
- Epidemiology, Janssen Research and Development, Titusville, NJ, USA
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12
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Perry BL, Yang KC, Kaminski P, Odabas M, Park J, Martel M, Oser CB, Freeman PR, Ahn YY, Talbert J. Co-prescription network reveals social dynamics of opioid doctor shopping. PLoS One 2019; 14:e0223849. [PMID: 31652266 PMCID: PMC6814254 DOI: 10.1371/journal.pone.0223849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/30/2019] [Indexed: 01/04/2023] Open
Abstract
This paper examines network prominence in a co-prescription network as an indicator of opioid doctor shopping (i.e., fraudulent solicitation of opioids from multiple prescribers). Using longitudinal data from a large commercially insured population, we construct a network where a tie between patients is weighted by the number of shared opioid prescribers. Given prior research suggesting that doctor shopping may be a social process, we hypothesize that active doctor shoppers will occupy central structural positions in this network. We show that network prominence, operationalized using PageRank, is associated with more opioid prescriptions, higher predicted risk for dangerous morphine dosage, opioid overdose, and opioid use disorder, controlling for number of prescribers and other variables. Moreover, as a patient's prominence increases over time, so does their risk for these outcomes, compared to their own average level of risk. Results highlight the importance of co-prescription networks in characterizing high-risk social dynamics.
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Affiliation(s)
- Brea L. Perry
- Network Science Institute, Indiana University, 1001 45/46 Bypass, Bloomington, IN, United States of America
- Department of Sociology, Indiana University, Bloomington, IN, United States of America
| | - Kai Cheng Yang
- School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States of America
| | - Patrick Kaminski
- Department of Sociology, Indiana University, Bloomington, IN, United States of America
- School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States of America
| | - Meltem Odabas
- Department of Sociology, Indiana University, Bloomington, IN, United States of America
| | - Jaehyuk Park
- School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States of America
| | - Michelle Martel
- Department of Psychology, University of Kentucky, Lexington, KY, United States of America
| | - Carrie B. Oser
- Department of Sociology, University of Kentucky, Lexington, KY, United States of America
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States of America
| | - Yong-Yeol Ahn
- Network Science Institute, Indiana University, 1001 45/46 Bypass, Bloomington, IN, United States of America
- School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States of America
| | - Jeffery Talbert
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States of America
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13
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Esposito DB, Cepeda MS, Lyons JG, Yin R, Lanes S. Medical record-based ascertainment of behaviors suggestive of opioid misuse, diversion, abuse, and/or addiction among individuals showing evidence of doctor/pharmacy shopping. J Pain Res 2019; 12:2291-2303. [PMID: 31413626 PMCID: PMC6661981 DOI: 10.2147/jpr.s203350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/24/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives Doctor/pharmacy shopping, the practice of seeking prescriptions from multiple healthcare sources without their coordination, may be a measure of prescription medicine abuse. This cross-sectional study examined the relationship between a claims-based doctor/pharmacy shopping definition and medical record documented behaviors suggestive of misuse, diversion, abuse and/or addiction. Methods Patients with ≥2 opioid dispensings starting in 2012 in a US administrative claims database were grouped into doctor/pharmacy shopping categories by number of providers and pharmacies used over 18 months: no shopping, minimal shopping, moderate shopping and severe shopping. Medical charts of opioid prescribers were reviewed to identify behaviors suggestive of misuse, diversion, abuse and/or addiction. Results Among 581,940 opioid users, 78% were classified as no shopping, 11% minimal shopping, 8% moderate shopping and 3% severe shopping. Almost 40% of severe shopping patients had no medical record documented behaviors (positive predictive value: 24.3%). Compared with no shopping, the odds ratio [OR] of ≥3 behaviors was 1.70 (95% confidence interval [CI] 0.50–5.78) for minimal shopping, 1.81 (95% CI 0.54–6.03) for moderate shopping, and 8.93 (95% CI 3.12–25.54) for severe shopping. Conclusions Claims-identified severe doctor/pharmacy shopping was strongly associated with behaviors suggestive of misuse, diversion, abuse and/or addiction, but the proportion of medical records documenting these was low.
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Affiliation(s)
- Daina B Esposito
- Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA
| | - M Soledad Cepeda
- Department of Research and Development, Janssen, Titusville, NJ, USA
| | - Jennifer G Lyons
- Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA
| | - Ruihua Yin
- Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA
| | - Stephan Lanes
- Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA
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Abstract
Opioid misuse, abuse, and diversion continues to be a public health issue. Pharmacists (particularly those who work in the community setting) form the vanguard of health-care providers facing the opioid crisis because they have the opportunity to interact with patients more frequently than primary care or specialty medical providers. These frequent interactions give pharmacists more opportunities to properly counsel patients on prevention and to reinforce appropriate use of opioid medications. Pharmacists should be aware of the strategies for reducing opioid misuse, abuse, and diversion, including understanding mandates on prescription limitations; knowing how to use prescription drug monitoring programs; knowing when drug take-back programs are occurring; educating patients on the risks of opioid abuse, safe storage, and proper disposal of unused medications; identifying "red flag" behavior that may indicate opioid misuse; using assessments that help identify a patient's risk for opioid abuse; interacting with other health-care professionals to discuss a patient's care; understanding how abuse-deterrent opioids work and their limitations; preparing for opioid overdose management and understanding the local regulations on naloxone availability; and knowing when to refer patients to addiction services. Using these strategies, pharmacists have an opportunity to potentially reduce opioid abuse and improve patient outcomes.
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15
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Young SG, Hayes CJ, Aram J, Tait MA. Doctor hopping and doctor shopping for prescription opioids associated with increased odds of high-risk use. Pharmacoepidemiol Drug Saf 2019; 28:1117-1124. [PMID: 31168860 PMCID: PMC6679752 DOI: 10.1002/pds.4838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE Early detection of risky behaviors involving prescription opioids can assist prescribers in implementing safer prescribing. Patient-to-prescriber travel patterns may indicate potential opioid misuse. We introduce doctor hopping, patients bypassing nearby prescribers in favor of more distant ones, as a new spatial estimation of potentially risky behavior, and compare with traditional doctor shopping metrics. METHODS We examined all filled opioid prescriptions between 2015 and 2016 from the Arkansas Prescription Drug Monitoring Program. We calculated patient-to-prescriber travel times and number of prescribers bypassed for each prescription, adjusted for payment method. Opioid recipients traveling further than the nearest urban area and bypassing more prescribers than 99% of other recipients from the same zip code were identified as doctor hoppers. We calculated odds ratios to evaluate how doctor hopping and doctor shopping correspond to high-risk opioid uses. RESULTS Approximately 0.72% of all opioid recipients in Arkansas engaged in doctor hopping two or more times during the study period. Rates of doctor hopping varied spatially but were more common in rural areas. Doctor shopping was more common in urban areas. Both hopping and shopping were significantly associated with higher odds of engaging in high-risk opioid use. The combination of doctor hopping and doctor shopping metrics can predict high-risk use better than either metric alone and may allow for earlier detection than doctor shopping alone. CONCLUSIONS Doctor hopping is positively associated with high-risk opioid use and is distinct from and complementary to doctor shopping. We recommend Prescription Drug Monitoring Program (PDMP) vendors incorporate similar spatial analyses into their systems.
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Affiliation(s)
- Sean G Young
- Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences College of Public Health, Little Rock, AR, USA
| | - Corey J Hayes
- Health Services Research and Development Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA
| | - Jonathan Aram
- Prescription Monitoring Program, Epidemiology Branch, Arkansas Department of Health, Little Rock, AR, USA
| | - Mark A Tait
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA
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16
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Lin HC, Wang Z, Simoni-Wastila L, Boyd C, Buu A. Interstate data sharing of prescription drug monitoring programs and associated opioid prescriptions among patients with non-cancer chronic pain. Prev Med 2019; 118:59-65. [PMID: 30316875 DOI: 10.1016/j.ypmed.2018.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/18/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
All fifty states have implemented prescription drug monitoring programs (PDMPs) to reduce misuse and diversion of controlled drugs. Interstate PDMP data sharing has been called for by clinical practitioners, but evidence to support the effectiveness of PDMP data sharing is lacking. This study examined whether PDMP interstate data sharing with bordering states was associated with prescriptions of opioids. This was a cross-sectional study that included patients with non-cancer chronic pain from the 2014 National Ambulatory Medical Care Survey (weighted N = 66,198,751; unweighted N = 2846). Multinomial logistic regression was performed to examine the association between PDMP interstate data sharing status and patients' being prescribed opioids for pain treatment, controlling for covariates guided by the Eisenberg's model of physician decision-making. Findings indicated that patients residing in states with interstate PDMP data sharing with all or partial bordering states were not less likely to be prescribed opioids compared to those living in states without interstate data sharing. Other factors such as patient age, health insurance type, new patient status, and physician adoption of electronic medical records were associated with the likelihood of patients' being prescribed opioids. This study concluded that current practice of interstate PDMP data sharing with bordering states was not associated with patients' being prescribed opioids for non-cancer chronic pain treatment. Future studies and policy efforts that unravel technological, legal, and political barriers to reciprocal and equal interstate data sharing with bordering states should be warranted to inform PDMP redesign and in turn, augment overall PDMP effectiveness in reducing misuse of prescription opioids.
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Affiliation(s)
- Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th Street, SPH 116, Bloomington, IN 47405, USA.
| | - Zhi Wang
- Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th Street, SPH 116, Bloomington, IN 47405, USA.
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, 20 North Pine Street, Baltimore, MD 21201, USA.
| | - Carol Boyd
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48109, USA.
| | - Anne Buu
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48109, USA.
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Biernikiewicz M, Taieb V, Toumi M. Characteristics of doctor-shoppers: a systematic literature review. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1595953. [PMID: 30956784 PMCID: PMC6442108 DOI: 10.1080/20016689.2019.1595953] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 05/17/2023]
Abstract
Objective: Doctor-shopping has significant consequences for patients and payers and can indicate misuse of drugs, polypharmacy, less continuity of care, and increased medical expenses. This study reviewed the literature describing doctor-shoppers in the adult population. Methods: A systematic literature review was performed in PubMed and supplemented by a Google search of grey literature. Overall, 2885 records were identified; 43 papers served as a source of definition of a doctor-shopper, disease, treatment, patient characteristics, patient special needs, country. Results: Definitions of doctor-shopping were heterogeneous. Overall, 40% of studies examined the use of opioids, antidepressants, or psychoactive drugs, while the others focused on chronic or frequent diseases. Most studies were conducted in countries with easy access to healthcare resources (USA, France, Taiwan, Hong Kong). The prevalence of doctor-shopping ranged from 0.5% among opioid users in the USA to 25% of patients registered at general practices in Japan. Comorbidities, active substance abuse, greater distance from healthcare facility, younger age, longer disease and poor patient satisfaction increased doctor-shopping. Conclusions: Knowing the characteristics of doctor-shoppers may help identify such patients and reduce the associated waste of medical resources, but concerns about the misuse of drugs or healthcare resources should not prevent proper disease management.
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Affiliation(s)
- Małgorzata Biernikiewicz
- Medical Writing and Publishing Department, Creativ-Ceutical, Cracow, Poland
- CONTACT Małgorzata Biernikiewicz Creativ-Ceutical, ul. Przemysłowa 12, Krakow30-701, Poland
| | - Vanessa Taieb
- HEOR Department, Evidence Synthesis Team, Creativ-Ceutical, London, UK
| | - Mondher Toumi
- Faculty of Medicine, Aix-Marseille University, Marseilles, France
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18
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Gisev N, Pearson SA, Dobbins T, Currow DC, Blyth F, Larney S, Dunlop A, Mattick RP, Wilson A, Degenhardt L. Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol. BMJ Open 2018; 8:e025840. [PMID: 30518593 PMCID: PMC6286479 DOI: 10.1136/bmjopen-2018-025840] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Opioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms. METHODS AND ANALYSIS We will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use. ETHICS AND DISSEMINATION This study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Drug and Alcohol Clinical Services, Hunter New England, Newcastle, New South Wales, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
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Ferries EA, Gilson AM, Aparasu RR, Chen H, Johnson ML, Fleming ML. Prevalence and Factors Associated with Multiple Provider Episodes in Texas: An Epidemiological Analysis of Prescription Drug Monitoring Program Data. PAIN MEDICINE 2018; 18:1941-1951. [PMID: 27744401 DOI: 10.1093/pm/pnw250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Prescription drug abuse has reached epidemic levels, leading to overdose-related morbidity and mortality. Patient and regional-level factors are believed to contribute to higher rates of prescription drug abuse. The objective of this study was to determine the prevalence and factors associated with multiple provider episodes (MPEs) in Texas. Methods This was a retrospective cohort analysis of data from the Texas Prescription Drug Monitoring Program (PDMP) database, linked with Texas county census data. Descriptive statistics and a multilevel model regression analysis were employed to estimate the prevalence of MPEs and examine the association between individual controlled substance prescription (CSP) utilization and county factors associated with MPEs. Results Among the 10,381,532 Texas residents utilizing CSPs in 2013, prescription opioids were the most frequently dispensed CSP (38.64%). The prevalence of MPEs was 71.30 per population of 100,000. Of those with MPEs, 76.98% received CSPs for more than 150 days and 11.48% had an average daily morphine equivalent dose (MED) 100 mg/day or higher. Residing in metropolitan areas, traveling more than 100 miles to obtain and fill prescriptions, chronic use of CSPs, younger age, and high MED were all significantly associated with increased risk of MPEs. Conclusions This study revealed that previous estimates of prescription drug abuse may be drastically underestimated. Prescription drug abuse is a major public health problem in Texas, especially in metropolitan areas. Therefore, prevention efforts need to be addressed at the individual level and through public health and policy legislation.
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Affiliation(s)
- Erin A Ferries
- University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas
| | - Aaron M Gilson
- Pain & Policy Studies Group, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, World Health Organization Collaborating Center on Pain Policy and Palliative Care, Madison, Wisconsin, USA
| | - Rajendar R Aparasu
- University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas
| | - Hua Chen
- University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas
| | - Michael L Johnson
- University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas
| | - Marc L Fleming
- University of Houston, College of Pharmacy, Pharmaceutical Health Outcomes & Policy, Houston, Texas
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Abstract
BACKGROUND We created an operational definition of possible opioid shopping in US commercial health insurance data and examined its correlates. METHODS The population consisted of 264,204 treatment courses in persons with a fill for an opioid or diuretic prescription in 2012 and a second within 18 months. We examined counts of prescribers and pharmacies and the numbers of fills and overlaps for ability to discriminate courses of opioids from diuretics, which were a negative control. The most discriminatory measure, indicating possible shopping behavior, was cross-tabulated against other prescriptions filled and diagnoses as found in insurance claims. The associations between claims characteristics and shopping behavior were assessed in a logistic regression. RESULTS A definition that classified possible "moderate" or "extensive" shopping when a person obtained drug through at least 3 practices and at least 3 pharmacies over 18 months was highly discriminatory between opioid and diuretic treatment. Overlaps between fills and number of fills did not improve the discrimination. Data from insurance claims strongly predicted moderate-to-extensive levels of possible shopping (c=0.82). Prominent among 20 significant predictors were: state of residence; amount of opioid dispensed; self-payment; use of nonspecialist prescribers; high use of anxiolytics, hypnotics, psychostimulants, and antipsychotics; and use of both immediate release and extended-release or long-acting opioids. CONCLUSIONS The use of ≥3 prescribing practices and ≥3 dispensing pharmacies over 18 months sharply discriminated courses of opioid treatment from courses of diuretics. This pattern of fills was additionally associated with the numbers of nonspecialist and self-paid fills, the total morphine milligram equivalents dispensed, and heavier use of drugs for anxiety, sleep, attention, and psychosis.
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21
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Blanch B, Buckley NA, Mellish L, Dawson AH, Haber PS, Pearson SA. Harmonizing post-market surveillance of prescription drug misuse: a systematic review of observational studies using routinely collected data (2000-2013). Drug Saf 2016; 38:553-64. [PMID: 25968812 DOI: 10.1007/s40264-015-0294-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Prescription drug misuse is a growing public health concern globally. Routinely collected data provide a valuable tool for quantifying prescription drug misuse. OBJECTIVE To synthesize the global literature investigating prescription drug misuse utilizing routinely collected, person-level prescription/dispensing data to examine reported measures, documented extent of misuse and associated factors. METHODS The MEDLINE, EMBASE, CINAHL, MEDLINE In Process, Scopus citations and Google Scholar databases were searched for relevant articles published between 1 January 2000 and 31 July 2013. A total of 10,803 abstracts were screened and 281 full-text manuscripts were retrieved. Fifty-two peer-reviewed, English-language manuscripts met our inclusion criteria-an aim/method investigating prescription drug misuse in adults and a measure of misuse derived exclusively from prescription/dispensing data. RESULTS Four proxies of prescription drug misuse were commonly used across studies: number of prescribers, number of dispensing pharmacies, early refills and volume of drugs dispensed. Overall, 89 unique measures of misuse were identified across the 52 studies, reflecting the heterogeneity in how measures are constructed: single or composite; different thresholds, cohort definitions and time period of assessment. Consequently, it was not possible to make definitive comparisons about the extent (range reported 0.01-93.5 %), variations and factors associated with prescription drug misuse. CONCLUSIONS Routine data collections are relatively consistent across jurisdictions. Despite the heterogeneity of the current literature, our review identifies the capacity to develop universally accepted metrics of misuse applied to a core set of variables in prescription/dispensing claims. Our timely recommendations have the potential to unify the global research field and increase the capacity for routine surveillance of prescription drug misuse.
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Affiliation(s)
- Bianca Blanch
- Pharmacoepidemiology and Pharmaceutical Policy Research Group, Faculty of Pharmacy, University of Sydney, A15-Pharmacy and Bank Building, Sydney, NSW, 2006, Australia,
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22
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Ong MS, Olson KL, Cami A, Liu C, Tian F, Selvam N, Mandl KD. Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines. J Gen Intern Med 2016; 31:164-171. [PMID: 26187583 PMCID: PMC4720655 DOI: 10.1007/s11606-015-3470-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 06/22/2015] [Accepted: 07/02/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prescription benzodiazepine overdose continues to cause significant morbidity and mortality in the US. Multiple-provider prescribing, due to either fragmented care or "doctor-shopping," contributes to the problem. OBJECTIVE To elucidate the effect of provider professional relationships on multiple-provider prescribing of benzodiazepines, using social network analytics. DESIGN A retrospective analysis of commercial healthcare claims spanning the years 2008 through 2011. Provider patient-sharing networks were modelled using social network analytics. Care team cohesion was measured using care density, defined as the ratio between the total number of patients shared by provider pairs within a patient's care team and the total number of provider pairs in the care team. Relationships within provider pairs were further quantified using a range of network metrics, including the number and proportion of patients or collaborators shared. MAIN MEASURES The relationship between patient-sharing network metrics and the likelihood of multiple prescribing of benzodiazepines. PARTICIPANTS Patients between the ages of 18 and 64 years who received two or more benzodiazepine prescriptions from multiple providers, with overlapping coverage of more than 14 days. RESULTS A total of 5659 patients and 1448 provider pairs were included in our study. Among these, 1028 patients (18.2 %) received multiple prescriptions of benzodiazepines, involving 445 provider pairs (30.7 %). Patients whose providers rarely shared patients had a higher risk of being prescribed overlapping benzodiazepines; the median care density was 8.1 for patients who were prescribed overlapping benzodiazepines and 10.1 for those who were not (p < 0.0001). Provider pairs who shared a greater number of patients and collaborators were less likely to co-prescribe overlapping benzodiazepines. CONCLUSIONS Our findings demonstrate the importance of care team cohesion in addressing multiple-provider prescribing of controlled substances. Furthermore, we illustrate the potential of the provider network as a surveillance tool to detect and prevent adverse events that could arise due to fragmentation of care.
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Affiliation(s)
- Mei-Sing Ong
- Children's Hospital Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Karen L Olson
- Children's Hospital Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Aurel Cami
- Children's Hospital Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Chunfu Liu
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA
| | - Fang Tian
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA
| | - Nandini Selvam
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA
| | - Kenneth D Mandl
- Children's Hospital Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA. .,HealthCore, Inc, Alexandria, VA, USA.
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Abstract
Objective Attention-deficit hyperactivity disorder (ADHD) medications are subject to abuse, misuse, and diversion. Obtaining ADHD prescriptions from multiple prescribers or filled across multiple pharmacies, known as ‘doctor shopping’, may reflect such unsanctioned use. We sought to create a definition of shopping behavior that differentiated ADHD medications from medications with low risk of diversion, i.e. asthma medications, and describe the incidence, frequency, and demography of shopping behavior. Methods This was a retrospective cohort study in a pharmacy database—LRx—covering 65 % of US retail pharmacies. Subjects had ADHD or asthma medication dispensed between February 2011 and January 2012. We followed subjects for 18 months to assess the number with overlapping dispensings from different prescribers, and the number of prescribers and pharmacies involved in those dispensings. Results We included 4,402,464 subjects who were dispensed ADHD medications, and 6,128,025 subjects who were dispensed asthma medications. Overlapping prescriptions from two or more prescribers dispensed by three or more pharmacies was four times more frequent in the ADHD cohort than in the asthma cohort. Using this definition, ADHD medication shopping behavior was more common among experienced users than naïve users, and was most common in subjects aged 10–39 years. Among subjects who shopped, 57.4 % shopped only once (accounting for 22.4 % of episodes), and 9.2 % shopped six or more times (accounting for 42.0 % of episodes). Shoppers more often received stimulant ADHD drugs than non-stimulants. Conclusions Overlapping prescriptions by different prescribers and filled at three or more pharmacies defines ADHD medication shopping. Shopping behavior is most common in adolescents and younger adults. A small proportion of shoppers is responsible for a large number of shopping episodes.
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Cepeda MS, Fife D, Berwaerts J, Friedman A, Yuan Y, Mastrogiovanni G. Doctor shopping for medications used in the treatment of attention deficit hyperactivity disorder: shoppers often pay in cash and cross state lines. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:226-9. [PMID: 25860878 PMCID: PMC4673524 DOI: 10.3109/00952990.2014.945591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Doctor shopping, defined by filling overlapping prescriptions from more than one prescriber at more than two pharmacies, is a way to obtain scheduled medications for diversion or abuse. Little is known about how far attention deficit hyperactivity disorder (ADHD) medication shoppers travel, how often they cross state lines to fill their ADHD prescriptions and how often they pay for their medication in cash, i.e. entirely out of pocket. OBJECTIVE We sought to describe the pattern of doctor shopping for ADHD medications: how far shoppers travel, how often they cross state lines to fill their prescriptions, and how often they pay in cash. METHODS Retrospective cohort study using LRx, a large US retail prescription database. We included subjects with any ADHD medication dispensed between 2011 and 2012. Subjects were followed for 18 months. RESULTS Of a total of 4 402 464 subjects exposed to ADHD medications, 0.4% developed shopping behavior. Women were more likely to become shoppers. Shoppers travelled a median of 91.9 miles and non-shoppers 0.2 miles to fill their ADHD prescriptions. Almost 28% of the shoppers filled prescriptions in >1 state compared with 4.3% of non-shoppers. Of the shoppers, 27.3% paid at least one prescription in cash compared to 14.4% of the non-shoppers. CONCLUSIONS Shoppers travelled larger distances, visited more states and paid in cash for ADHD medications more often than non-shoppers. Data sharing among prescriptions monitoring programs can improve their effectiveness and drug utilization studies should take account of cash purchases.
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25
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Degenhardt L, Blanch B, Gisev N, Larance B, Pearson S. The POPPY Research Programme protocol: investigating opioid utilisation, costs and patterns of extramedical use in Australia. BMJ Open 2015; 5:e007030. [PMID: 25631315 PMCID: PMC4316424 DOI: 10.1136/bmjopen-2014-007030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Opioid prescribing is increasing in many countries. In Australia, there is limited research on patterns of prescribing and access, or the outcomes associated with this use. The aim of this research programme is to use national dispensing data to estimate opioid use and costs, including problematic or extramedical use in the Australian population. METHODS AND ANALYSIS In a cohort of persons dispensed at least one opioid in 2013, we will estimate monthly utilisation and costs of prescribed opioids, overall and according to individual opioid formulations and strengths. In a cohort of new opioid users, commencing therapy between 1 July 2009 and 31 December 2013, we will examine patterns of opioid use including initiation of therapy, duration of treatment and concomitant use of opioids and other prescribed medicines. We will also examine patterns of extramedical opioid use based on indicators including excess dosing, use of more than one opioid concomitantly, doctor/pharmacy shopping and accelerated time to prescription refill. ETHICS AND DISSEMINATION This protocol was approved by the NSW Population and Health Services Ethics Committee (March 2014) and data access approved by the Department of Human Services External Review Evaluation Committee (June 2014). This will be one of the first comprehensive Australian studies with the capability to investigate individual patterns of use and track extramedical use. In the first instance our analysis will be based on 5 years of dispensing data but will be expanded with ongoing annual data updates. This research has the capability to contribute significantly to pharmaceutical policy within Australia and globally. In particular, the trajectory of extramedical prescription-opioid use has been the subject of limited research to date. The results of this research will be published widely in general medical, pharmacoepidemiology, addiction and psychiatry journals.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Bianca Blanch
- Faculty of Pharmacy, Pharmacoepidemiology and Pharmaceutical Policy Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Sallie Pearson
- Faculty of Pharmacy, Pharmacoepidemiology and Pharmaceutical Policy Research Group, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Cepeda MS, Fife D, Kihm MA, Mastrogiovanni G, Yuan Y. Comparison of the risks of shopping behavior and opioid abuse between tapentadol and oxycodone and association of shopping behavior and opioid abuse. Clin J Pain 2014; 30:1051-6. [PMID: 24370606 PMCID: PMC4232297 DOI: 10.1097/ajp.0000000000000067] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 12/11/2013] [Indexed: 12/03/2022]
Abstract
OBJECTIVES This study compared the risks of opioid shopping behavior and opioid abuse between tapentadol immediate release and oxycodone immediate release and, to validate the definition of shopping, examined the association between opioid shopping and opioid abuse further. MATERIALS AND METHODS This retrospective cohort study using linked dispensing and diagnosis databases followed opioid-naive patients for development of shopping behavior and/or opioid abuse during 1 year after initial exposure to tapentadol or oxycodone. Shopping was defined by having overlapping opioid prescriptions from >1 prescriber filled at ≥3 pharmacies; abuse by having International Classification of Diseases, 9th revision diagnoses reflecting opioid abuse, addiction, or dependence. To determine their association, we cross-tabulated shopping and opioid abuse and calculated odds ratios. Risks of developing each outcome were estimated using logistic regression. RESULTS Among 277,401 participants initiating opioid use with tapentadol (39,524) or oxycodone (237,877), 0.6% developed shopping behavior, 0.75% developed abuse. Higher proportions of patients in the oxycodone group developed shopping behavior and abuse than in the tapentadol group (shopping: adjusted odds ratio [95% confidence interval], 0.45 [0.36-0.55]; abuse: 0.44 [0.37-0.54]). Shopping behavior and abuse were associated; of those with shopping behavior, 6.5% had abuse. Age (18 to 64 y), sex (male), prior benzodiazepine use, paying cash, and history (mood disorders, abuse of nonopioid medications, and back pain) were risk factors for developing either outcome. DISCUSSION Shopping behavior and abuse measure complementary, but associated, constructs, which further validates the current definition of shopping. The risk of developing either is lower among patients who initiate opioid use with tapentadol than those who initiate opioid use with oxycodone.
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Affiliation(s)
| | - Daniel Fife
- Janssen Pharmaceutical Research & Development LLC, Titusville, NJ
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McDonald DC, Carlson KE. The ecology of prescription opioid abuse in the USA: geographic variation in patients' use of multiple prescribers ("doctor shopping"). Pharmacoepidemiol Drug Saf 2014; 23:1258-67. [PMID: 25111716 DOI: 10.1002/pds.3690] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/19/2014] [Accepted: 07/14/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE This study estimates the prevalence in US counties of opioid patients who use large numbers of prescribers, the amounts of opioids they obtain, and the extent to which their prevalence is predicted by ecological attributes of counties, including general medical exposure to opioids. METHODS Finite mixture models were used to estimate the size of an outlier subpopulation of patients with suspiciously large numbers of prescribers (probable doctor shoppers), using a sample of 146 million opioid prescriptions dispensed during 2008. Ordinary least squares regression models of county-level shopper rates included independent variables measuring ecological attributes of counties, including rates of patients prescribed opioids, socioeconomic characteristics of the resident population, supply of physicians, and measures of healthcare service utilization. RESULTS The prevalence of shoppers varied widely by county, with rates ranging between 0.6 and 2.5 per 1000 residents. Shopper prevalence was strongly correlated with opioid prescribing for the general population, accounting for 30% of observed county variation in shopper prevalence, after adjusting for physician supply, emergency department visits, in-patient hospital days, poverty rates, percent of county residents living in urban areas, and racial/ethnic composition of resident populations. Approximately 30% of shoppers obtained prescriptions in multiple states. CONCLUSIONS The correlation between prevalence of doctor shoppers and opioid patients in a county could indicate either that easy access to legitimate medical treatment raises the risk of abuse or that drug abusers take advantage of greater opportunities in places where access is easy. Approaches to preventing excessive use of different prescribers are discussed.
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