Female Doctor Shoppers Give Candid Insights Into Their Prescription Drug Abuse
Study Findings Identify Measures to Help Reduce Doctor Shopping
A nurse researcher at Rush University Medical Center has conducted a first-of-its-kind, qualitative study to gain a better understanding of doctor shopping involving women. Results were published in a recent online issue of the Western Journal of Nursing Research.
Doctor shopping is a phenomenon in which patients visit numerous hospital emergency rooms as well as offices of physicians, nurse practitioners, dentists and other prescribers to obtain multiple prescriptions for controlled drugs — such as pain killers — to feed their drug addiction.
“Prescription drug abuse is a serious and significant worldwide problem,” said Julie Worley, lead investigator of the study and assistant professor of nursing at Rush University. “Studies have shown that women are more likely to use doctors' prescriptions for abuse and engage in doctor shopping than men.”
“The problem of doctor shopping is significant to doctors and advanced practice nurses such as nurse practitioners as prescribers who have a legal and ethical obligation to prescribe responsibly,” said Worley. “We are on the front lines and have the potential to intervene in this phenomenon if we know what questions to ask, what steps to take and what signs to look for.”
For the study, detailed, candid interviews were conducted with 14 women ranging in age from 27-51, who were recruited from substance abuse support groups, fliers and through word of mouth. The women self-identified as having engaged in doctor shopping.
Twelve women were white and two were African American from the southeastern United States. Each chose a pseudonym and participated in one-on-one, 45-minute-to-90-minute interviews with the lead investigator of the study at a private office, private location near the recruitment site or at the participants’ homes, which included a halfway house for women.
Four universal themes were identified from interview transcripts, including the following:
1. Feeding the addiction – The driver of the behavior of engaging in doctor shopping for all the participants was the drug addiction.
One participant "Melissa" described her send of being overpowered by the addiction.
“I would have a prescription and go to another one, another doctor, knowing I already had it, wanting to get more, just to feed my addiction," said "Melissa."
2. Networking with other addicts – The participants worked with people whom they referred to as addicts in their circle or network by getting information and acting together. They would share information among each other about where to go to doctor shop and how to do it. Information about which pharmacies were more likely to fill the prescription was also shared. Addicts would also work together by sharing pills for pill counts, trading X-ray or other diagnostic imaging results or share rides to appointments.
3. Playing the system – The addicts would find sophisticated ways to play the system to elude detection such as sharing diagnostic imaging results, fixing urine samples for drug testing and driving to different pharmacies.
4. Baiting the doctors – Participants in the study would con and manipulate the prescribers to write prescriptions for controlled drugs that they need to feed their addiction. Baiting was accomplished by falsifying symptoms, denying or hiding the fact that prescriptions had already been obtained from previous prescribers and dramatically feigning symptoms of anxiety or pain.
"Summer", one of the participants, talked about conning prescribers.
“Just hearing my sob self-pity story, they just fell into that and gave me all kinds of narcotics. They just fell for my sob story and I used that to bait them doctors,” said "Summer."
"Jane", who is one of the participants, was so desperate for prescription drugs; she even underwent unnecessary, painful elective surgeries. In addition, she would use the tactic of becoming belligerent and making a scene until she go the drugs she wanted.
“I got so desperate I let them do surgeries on me. That’s part of being a con artist and manipulator. I was going to get what I wanted and I would trouble as I could until it went my way,” said "Jane."
“There are several implications that can be drawn from the results of this study,” said Worley. “In the interviews from this study one new finding is the description of the act of doctor shopping as having the potential of being addicting itself.”
“There is a great need for responsible prescribing practices where steps are taken to identify when patients are doctor shopping in order to stop the cycle of abuse. When abuse is identified, measures should be taken to help people get treatment,” said Worley. “When prescribers write prescriptions for controlled drugs to people who are abusing them, prescribers are essentially contributing to a serious and potentially deadly disease.”
“We need to put into place screening to detect prescription drug abuse whenever controlled drugs are prescribed,” said Worley.
Steps that should be taken include: checking prescription drug monitoring program data, the use of sophisticated urine drug screening, treatment contracts, pill counts, physical examination of patients for needle track marks, better way to confirm patients’ identities and insurance statuses as well as discouraging the use of cash payments for visits or prescriptions for controlled drugs, a mechanism to detect or prevent patients routinely traveling out of town to visit prescribers or to fill prescriptions for controlled drugs, a need for increased prescriber education on responsible prescribing, identification and assessment of abuse and how to handle the situation when abuse or addiction is detected.
Further research is needed regarding doctor shopping.
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