“Doctor Shoppers” Travel Long Distances, Over State Lines to Fill Overlapping Prescriptions for Attention-Deficit/Hyperactivity Disorder Medications

“Doctor shopping” (obtaining overlapping prescriptions from different prescribers and pharmacies) is one way people obtain stimulants prescribed for attention-deficit/hyperactivity disorder (ADHD) for non-medical use. Prescription monitoring programs (PMP) help guard against this behavior, but they are state-based and generally do not provide information on prescriptions filled in other states. Researchers used a large prescription database (covering 65% of retail dispensing) to identify people who filled prescriptions for medications used to treat ADHD (a number of stimulants and clonidine) at multiple pharmacies.

• A total of 4.4 million individuals filled at least 1 ADHD medication over a yearlong period.
• “Shopping,” defined as filling overlapping ADHD prescriptions from more than 1 prescriber and more than 2 pharmacies, occurred in 15,996 subjects (0.45%). “Heavy shopping” (≥ 5 shopping episodes over 18 months) occurred in 2,134 subjects (0.05%).
• While only 4% of non-shoppers had ADHD prescriptions filled in more than 1 state, this behavior was observed in 28% of shoppers and 43% of heavy shoppers. Shoppers travelled a median of 92 miles to fill prescriptions, heavy shoppers 333 miles, and non-shoppers 0.2 miles.
• Shoppers and heavy shoppers were more likely to pay in cash for at least 1 ADHD prescription (27%) than non-shoppers (14%).

Comments:

This study provides a glimpse into the lengths that a small subset of the population will go to obtain ADHD medications for non-medical use. State-based PMPs need to share information across state borders, and pharmacies should be wary of individuals travelling long distances and over state lines to fill controlled substance prescriptions. Another potential measure would be to provide prescribers with information from large databases like this one.

Darius A. Rastegar, MD

Reference:

Cepeda MS, Fife D, Berwaerts J, et al. Doctor shopping for medications used in the treatment of attention deficit hyperactivity disorder: shoppers often pay cash and cross state lines. Am J Drug Alcohol Abuse. 2015;41(3):226–229.