Patients who are “doctor-shopping” for opioids and other controlled substances tend to be white, show up in emergency departments (EDs) on weekends, complain of back pain, and request medications by name, a new study co-authored by a Boston University School of Public Health (SPH) researcher shows.
The study, published in the Journal of Emergency Medicine, recommends that physicians use certain clinical characteristics to “identify high-risk patients and then target [them] for more in-depth counseling or screening” before writing a prescription. Kerrie Nelson, an SPH research associate professor of biostatistics, was a co-author on the study, along with researchers from Tufts Medical Center, Boston Medical Center, and Carolinas Medical Center.
The research team reviewed records of 544 patients who had presented to two hospital emergency departments with a chief complaint of back pain, dental pain, or headaches. They defined “doctor-shoppers” as patients who had prescriptions for Schedule II–V drugs filled from eight or more providers within one year.
About 12 percent of the patients had “doctor-shopping” behavior. Those patients were more likely to request medications by name and to report allergies to non-narcotic medications than other patients, after accounting for gender, age, and race. Nearly 69 percent of them were white, compared to 40.3 percent of patients not identified as doctor shopping. Back pain was the chief complaint among the three studied, and patients were more likely to visit the emergency room on the weekend than other patients, the study found.
“We propose that knowledge of these factors, in addition to utilization of screening tools, paying close attention to prior psychosocial factors that predispose to abuse and addiction, and routinely accessing [state Prescription Drug Monitoring Program data] . . . will lead to more informed prescribing of scheduled medications from the ED,” the authors said.
Opioid prescribing in the US has increased dramatically in recent years, as have reported overdoses. Deaths from prescription opioid pain relievers now surpass those from heroin and cocaine combined, the authors noted.
At the same time, they said, there is concern that pain may be undertreated in the emergency department.
“This situation creates a conundrum for clinicians working in the ED who need to both compassionately treat patients’ pain, but also steward the use of opioids to prevent addiction and unintentional overdose in patients at risk of abusing them,” the researchers wrote.
Researchers from Boston Medical Center’s emergency medicine department included Breanne Langlois, Patricia Mitchell, and James Feldman, professor of emergency medicine at the BU School of Medicine.