HCPLive Network

Advice on How to Spot a Doctor Shopper

 
The brochure “Ever Been Scammed? Learn How to Protect Yourself from Those Seeking to Abuse Medications” was developed by the Pennsylvania Medical Society for physicians who are looking for information and resources “to help them differentiate patients with pain from those seeking to abuse or divert prescription medications.”
 
This 12-page brochure provides working definitions of “tolerance,” “dependence,” and “addiction;” discusses factors that may have contributed to the increase in opioid misuse and abuse; and identifies “red flags” that may be exhibited by individuals who are in search of prescription painkillers beyond what is therapeutically required.
 
Potential red flags that may indicate a patient is a doctor shopper include patients who:
  • Present with a poorly defined or difficult to diagnose injury
  • Deliver well-rehearsed stories of pain, stress, or insomnia
  • Refuse non-addictive alternatives and insist on addictive alternatives
  • Push for the maximum amount/largest quantity of an addictive drug
  • Tell physician which drugs work best
  • Routinely request early refills or replacement prescriptions
  • Make frequent claims of lost or stolen medication
 
The brochure also identifies several valuable resources that can help physicians identify drug seekers, including the Current Opioid Misuse Measure (COMM), which is available for download at PainEdu.org; the Addiction Behaviors Checklist, which is “a 20-item questionnaire designed to track behaviors that are characteristic of opioid addiction in chronic pain populations” that is available at the Partners Against Pain website; and the Pain Assessment and Documentation Tool, which measures “the four A’s of pain treatment outcomes: analgesia, activities of daily living, adverse effects, and aberrant drug taking,” and is available at the HealthInsight website.
 
Physicians will also find guidance on documenting a pain assessment, the benefits of using their state’s prescription drug monitoring database (PDMD), referring patients for substance abuse counseling and treatment, and the proper disposal of opioid medications.
 
 

Further Reading
The Canadian government’s recent decision to allow the sale of a generic version of the original formulation of OxyContin could have serious consequences for efforts to curb opioid abuse, misuse, and diversion in the US.
The push to provide better pain care and ensure adequate analgesia for patients living with chronic pain led to liberalized opioid prescription practices that have been accompanied by a massive increase in the abuse, misuse, and diversion of prescription opioids. Efforts to combat this include technological remedies such as “abuse-deterrent” formulations of opioids and educational approaches such as the REMS program approved by the FDA in 2012.
While the peak of the opioid epidemic may now have been reached (according to some), we are not out of the woods. Every decision to start or continue opioid therapy must be careful, deliberate, and weigh benefit against risk, while keeping in mind that risk is not constant/static, but dynamic and evolves through time.
The rate of non-medical use of prescription pain relievers in the past year among individuals aged 12 years and older is estimated at 4.6 percent nationally, with considerable variation between states, according to a study published online Jan. 8 by the Substance Abuse and Mental Health Services Administration.
Declaring that the benefits of the original formulation of OxyContin no longer outweigh the risks of misuse and abuse, the FDA announced it would not approve any applications for non-tamper resistant formulations of the drug, a decision that could have far-reaching implications for all makers of opioid medications.
Even if a chronic pain patient had been taking opioid medications exactly as prescribed, it would still be possible for the patient to experience negative cognitive and emotional responses to dose tapering that could amplify sensory pain and lead to opioid addiction.
Steve Gelfand, MD, secretary of Physicians for Responsible Opioid Prescribing (PROP) responds to recent comments by Drs. Cole and Webster in Pain Management.
More Reading