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How to Spot ‘Doctor-Shopping’ Patients Seeking Opioids at ED

BOSTON – If a white patient shows up at your emergency department during the weekend, complains of back pain and ask for medications by name, you have good reason to suspect “doctor shopping” for opioids and other controlled substances.

That’s according to a study published recently in the Journal of Emergency Medicine.Study authors, led by researchers from Tufts Medical Center in Boston, recommend that ED physicians use specific clinical characteristics to “identify high-risk patients and then target [them] for more in-depth counseling or screening” before writing a prescription.

To come up with the common characteristics, the research team reviewed records of 544 patients who had presented to two hospital EDs with a chief complaint of back pain, dental pain, or headaches. “Doctor-shoppers” were defined as patients who had prescriptions for Schedule II-V drugs filled from eight or more providers within one year.

About 12% were found to have doctor-shopping (DS) behavior and 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.

Of those patients, nearly 69% were white compared to 40.3% of patients not identified as doctor shopping. Back pain was more often the complaint than headache or dental pain, and patients were more likely to visit the emergency room on the weekend than other patients, the study found.

Results indicate that DS and non-DS patients were similar in sex but differed in age, race, chief complaint and weekday vs. weekend arrival. They also utilized a median of 12 providers compared to a median of one for the non-DS group.

“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 write.

The researchers said the danger is taking the vigilance too far, which could result in undertreatment of pain in EDs.

“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 authors write.