Healthcare Coalition Highlights Red Flags of Doctor Shopping
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In the battle against the prescription drug epidemic, a powerful coalition released a consensus document this month to provide healthcare professionals with the warning signs of prescription drug misuse and diversion. The members of this united coalition include the American Medical Association (AMA), the American Pharmacists Association, the National Association of Boards of Pharmacy, CVS Health, and Walgreens. The goal is to ensure that healthcare professionals are aware of the red flags that signal doctor shopping. The coalition document is available on the AMA website.
Doctor shopping is a drug-seeking practice where substance misusers go from one doctor to another in an attempt to accumulate prescriptions, often for opioid painkillers. Although needle tracks in the arms, dilated pupils, and slurred words are obvious signs of drug-seeking patients, other signs are not so obvious. Beyond the misuse of the prescription drugs, doctor shoppers’ intent often is to sell them on the street at a huge markup.
Some of these subtle red flags include:
1. Dropping the street name of a drug in a conversation, such as "Roxi's" for Percocet or "Oxys" for OxyContin.
2. Refilling prescriptions ahead of schedule and claiming to have misplaced the drugs or had them stolen.
3. Declining a physical examination from a doctor.
4. Providing prescriptions lacking common medical abbreviations.
Aimed at prescribers and prescription-fillers, the consensus document provides profiles of doctor-shoppers. They have a tendency to pressure physicians and pharmacists to fill out their prescriptions with implied or actual threats of harm. The consensus statement suggests that whenever such a threat is made or implied, physicians and pharmacists should avoid a confrontation, and then contact authorities to report what happened.
A disclaimer appears in a box at the bottom of almost every page of the document. With doctor-shoppers dying of overdoses, and some physicians going to prison, the coalition does not want to cause any additional problems. Although such aberrant behaviors, as described above, are common, the document makes it clear that none of them positively mark a person as a drug misuser, doctor shopper, or drug pusher.
The coalition points out that state prescription monitoring programs (PMPs) can help healthcare professionals spot a doctor shopper. The problem is that PMP data is often incomplete or not readily available. The coalition consensus document prescribes communication and collaboration to surmount such challenges. At the same time, patients with a legitimate need for controlled substances need to be ensured access to the prescription drugs. Without question, preventing doctor shopping is a real challenge for both prescribers and prescription-fillers given the difficulties involved.