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Estimating the Prevalence of ‘Doctor Shopping' for Prescription Drugs


  • Doctor shopping’s contribution to opioid misuse wasn’t well understood.
  • Abt used a novel statistical method to analyze 146.1 million prescriptions.
  • Drug monitoring programs must improve to address suspicious opioid purchasing patterns.
The Challenge

Misuse of opioid analgesics threatens public health and results in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. In the absence of adequate patient information systems, patients who engage in “doctor shopping” can obtain multiple opioid prescriptions for nonmedical use from a number of unaware physicians. The extent of doctor shopping and its contribution to the growing epidemic of opioid misuse was insufficiently understood.

The Approach

Through a grant from the National Institute on Drug Abuse, Abt undertook a study that estimated the prevalence of doctor shopping in the United States and the amounts and types of opioids involved. Abt researchers examined a sample that included 146.1 million opioid prescriptions dispensed during 2008 by 76 percent of retail pharmacies in the United States. Using a novel statistical method, they developed national, state and county estimates for the first time.

The Results

Abt found that outlier patients presumed to be doctor shoppers – 0.7 percent of purchasers – obtained on average 32 opioid prescriptions from 10 prescribers during 2008. These patients bought an estimated 4.3 million prescriptions, about four percent of prescribed opioids by weight. The results supported a recommendation that prescription drug monitoring programs improve access and response time, scan prescription data to flag suspicious purchasing patterns and increase practitioner participation. Practitioners should screen new patients for risk of abuse and monitor adherence to treatment. A companion study of variation in physicians’ prescribing practices, using the same data, suggested insufficient guidance to prescribers was a more significant contributor to the epidemic than doctor shopping patients were.

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