By Wesley H. Gallagher
Opioid-related deaths exceeded 33,000 for the first time in 2015, despite increased efforts to curb the epidemic. Almost half of those deaths involved prescription opioids.1 In a recent press conference, President Donald Trump even officially declared the opioid crisis in America a national emergency. But what can healthcare and government agencies do to turn the tide?
One practice contributing to the current crisis is “doctor shopping,” in which patients seek prescription painkillers to feed their opioid addiction, often seeing several doctors simultaneously and filling prescriptions at multiple pharmacies. In an example from a report released by the Inspector General of the US Department of Health and Human Services, one Medicare beneficiary received 73 prescriptions for opioids from 11 prescribers and filled them at 20 different pharmacies.1
The Inspector General’s report found that some 22,000 Medicare Part D beneficiaries appeared to be doctor shopping in 2016. Each of these patients received a morphine equivalent dose (MED) of greater than 120 mg a day, which is well above the CDC-recommended limit of 90 mg. They also received these opioids for at least three months and had more than four prescribers and more than four pharmacies.1
Statistics like these indicate that a patient is likely seeking drugs that are medically unnecessary, whether to fuel an addiction, use them recreationally or sell them illegally.
What Is Being Done to Prevent Doctor Shopping?
All 50 states have a general fraud statute that prevents patients from obtaining narcotic drugs by fraud, and at least 20 states (as of 2012) have specific doctor shopping laws.2
Every state except Missouri also has a prescription drug monitoring program (PDMP) designed to track people at high risk for opioid abuse. These programs allow doctors to check state drug registries before writing prescriptions. States that require doctors to check the registries have seen an 80 percent reduction in doctor shopping, and voluntary states have seen a 56 percent decrease.3
While these statistics are promising, such laws and programs address the patient’s role in doctor shopping, which is only part of the problem.
Patients Aren’t the Only Ones to Blame
Doctor shopping statistics from reports like the Inspector General’s indicate, at the very least, poor coordination of patient care on the part of prescribers. Many doctor shoppers cross state lines to obtain prescriptions, and PDMPs only track prescriptions dispensed within state borders, which could make it difficult for prescribers to track potential doctor shopping. Some prescribers might not even be consulting PDMPs before writing prescriptions. The most troubling indication, however, is that many prescribers are actually complicit in the practice of doctor shopping.
The Inspector General’s report found over 400 prescribers with questionable prescribing practices in 2016 and 264 prescribers who provided opioids for large numbers of Medicare beneficiaries who appeared to be doctor shopping.1 These are not medical practitioners who are being taken advantage of — these are practitioners who are knowingly prescribing medically unnecessary opioids to dozens of patients.
Doctor Shopping Is a Symptom, Not a Cause
While doctor shopping and prescribers who knowingly participate in the practice are glaring issues that need to be addressed, they are merely symptoms of a much larger systemic issue in America.
The quadrupling of death rates from opioid overdose since 1999 coincides with the quadrupling of sales of opioids over the same period of time.3 The US consumes more than 80 percent of opioids in the world, despite having less than five percent of the population.4 At the recommendation of the pharmaceutical companies manufacturing — and profiting from — these opioids, even well-meaning doctors routinely over-prescribe pain medication.
Studies show that patients are at risk for continuing opioids long-term after only five days of use and are unlikely to discontinue use after receiving them for 90 days.5 Despite such statistics, opioids are prescribed at astounding rates for even minor pains and surgeries. Americans have been trained to believe that they deserve to be pain-free, no matter what their ailment, and that opioid painkillers are a safe way to achieve this goal.
The reality is that even seemingly harmless initial prescriptions of opioids can lead to abuse and addiction.
All of the statistics surrounding doctor shopping and the opioid crisis show that multiple factors contribute to the crisis, which means efforts to curb it must be similarly multifaceted. Patients must be prohibited from obtaining excessive amounts of painkillers, and prescribers must be held accountable for prescribing patterns that contribute to doctor shopping. Prescribers must also receive the training and resources needed to amend their prescribing protocols to stop opioid abuse before it starts. And this must begin at the top — from government agencies working to solve the problem and pharmaceutical companies who have contributed largely to the problem.
Fortunately, reports like the Inspector General’s shed much needed light on the issue and call for various efforts to curb the crisis. Among these suggestions are the strengthening of health surveillance, the advancement of the practice of pain management, improved access to treatment and recovery services, increased availability and distribution of overdose-reversing drugs and support of cutting-edge research. The hope is that, with a well-rounded approach to the opioid crisis and its myriad causes, statistics will be transformed and the lives of many Americans will be saved.
1 “Opioids in Medicare Part D: Concerns About Extreme Use and Questionable Prescribing.” US Department of Health and Human Services, Office of the Inspector General, Accessed September 8, 2017.
2 “Doctor Shopping Laws.” Centers for Disease Control and Prevention, Accessed September 8, 2017.
3 “Prescription-Drug Monitoring Cuts Doctor-Shopping for Painkillers.” Fox News, February 17, 2017.
4 McGreal, Chris. “Don’t blame addicts for America’s opioid crisis. Here are the real culprits.” The Guardian, August 13, 2017.
5 Guy Jr., Gery P., et al. “Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015.” Centers for Disease Control and Prevention, July 7, 2017.