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Small number of doctor shoppers have big impact

They make up a very small percentage of people filling prescriptions but the amount of opioids they buy, feeding their own addiction or others’, is alarming.

“Doctor shoppers,” or people who visit multiple physicians’ offices and pharmacies soliciting the highly-addictive drugs, accounted for about 7 of every 1,000 people who filled a prescription for narcotic painkillers in 2008. But they purchased nearly 4 percent sold that year, according to a study by Cambridge researchers published Wednesday evening on PLOS ONE.

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The study used a national market research database including more than 146 million opioid prescriptions from 2008, capturing people who shop in multiple states, and identified the outliers. The 0.7 percent of patients who were more likely abusing the system on average filled 32 prescriptions from 10 different doctors that year, the researchers found.

“A substantial proportion of patients are seeing doctors in different states, and filling prescriptions in different states,” said Doug McDonald, a study author and sociologist at Abt Associates who is still finalizing those figures for an upcoming study. “That says that state-centered programs are not good enough.”

Prescription opiate abuse is a growing and fueling addiction to cheaper heroin in New England and across the country. The rate of drug overdose deaths has more than tripled since 1990, and most in 2008 were caused by prescription drugs, according to the Centers for Disease Control and Prevention. But regulators have tried to balance the need to identify doctor-shoppers with patient privacy and physician concern about surveillance of their prescribing habits.

“It’s the NSA problem, in the health world,” McDonald said. “What do you do with all these data, and how do you trust people with it?”

While some states have long-established widely-used prescription monitoring programs, Massachusetts only last year required providers, when they apply for or renew a medical license, to be registered to use the database and to consult it before prescribing the powerful painkillers to patients who are new to their practice.

Sixteen other states have begun to use a large data sharing network, run by the National Association of Boards of Pharmacy.

Chelsea Conaboy can be reached at Follow her on Twitter @cconaboy.
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