Doctor Shopping and Addiction
Doctor shopping is a complex phenomenon that entails seeing multiple treatment providers in an attempt to procure multiple prescriptions for habit-forming medications. It is typically a sign of a serious substance use disorder. It can involve opioids, benzos, antidepressants, stimulants or other addictive substances.
Doctor shopping encompasses patient safety, addiction risk, medical ethics and healthcare fraud. It is considered an illegal practice in the US with federal policies as well as individual state policies in place to address the issue.
Doctor shopping is dangerous. It can result in delayed or inaccurate diagnosis of conditions as well as inappropriate treatment. It can strain healthcare resources that many people depend on. It has fueled the opioid overdose epidemic. And it contributes to the rise in substance addiction. Understanding the behaviors of doctor shopping is important because it can be a warning sign of medication misuse, untreated pain or unmanaged mental health conditions.
What is Doctor Shopping?
Doctor shopping is when a person visits multiple clinicians to obtain controlled substances without the prescriber’s knowledge of other prescriptions from other doctors. Patients fail to share information about other prescriptions they are receiving to maximize the number of substances they have access to. Doctor shopping typically entails receiving prescriptions from five or more clinicians during a year.
There are many restrictions put on controlled substances. They are often restricted to specific doses, amounts and refills. This can be limiting to someone who is misusing the substance. Doctor shopping is a way users manipulate the system to fuel their addictive behaviors.
Doctor shopping is a pattern of deception, duplication and unsafe medication seeking.
- Lying about symptoms
- Deny receiving previous medications
- Omit information purposefully
- Claim they have lost prescriptions
- Conceal recent refills or prior diagnosis
- Lie about the use of other substances
A patient can legitimately see several providers. A person with cancer, chronic pain, anxiety or a complex medical history can have access to a primary care doctor, a specialist and a therapist. All of these doctors are able to prescribe medications. Doctor shopping can come with significant risks, including risk of addiction and overdose.
Why does Doctor Shopping happen?
Doctor shopping for addictive substances can happen for many reasons. Some people are trying to manage real pain, anxiety, insomnia or withdrawal symptoms. Others may be selling medications, sharing pills, or using prescriptions in a way in which they were not intended.
Some studies found that doctor shopping was associated with high rates of mental health conditions. Other studies found that it was closely associated with obtaining prescription medications that were habit-forming and can lead to addiction.
- A person has become addicted to the substance and is attempting to get more for personal use
- A person may be selling the drugs because they are in high demand and want to make a financial profit
- Tolerance or dependence. The person feels the prescribed dose no longer works and they fear withdrawal
- Fragmented healthcare where different clinicians do not communicate records smoothly across systems
- A person may have fear of stigma and hide use because they are worried about being judged or cut off
- A person may feel panic, fear or believe their symptoms are not being controlled properly or effectively
The warning signs of Doctor Shopping
Drug-seeking behavior can be subtle. There is no single sign that proves someone is addicted to substances. It is patterns and behaviors over time that occur.
- Repeatedly requesting specific medications, especially in high doses
- Reporting lost, stolen or destroyed prescriptions more than once
- Seeking early refills without clear explanation
- Visiting multiple emergency departments, urgent care clinics or prescribers for the same issue
- Refusing non addictive or non-medicinal options
- Using several pharmacies without a practical reason
- Becoming angry or aggressive when medication is not prescribed
- Withholding information about other prescriptions or medications being used
- Having multiple appointments with different medical providers in a short period of time
- Frequent complaints about medical providers unwilling to provide certain prescriptions
- Making multiple appointments with medical providers in different locations, counties or states to conceal prescriptions
- Overusing or running out of medications quickly and resulting in panic to get refills
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Laws, Policies and Regulations pertaining to Doctor Shopping
Doctor shopping is illegal and considered a federal offense. The Narcotic Drug Act of 1932 and the Controlled Substances Act of 1970 are policies that help mitigate doctor shopping in the US. The laws state that no person shall obtain a narcotic drug by fraud, deceit, concealment of material fact or misrepresentation.
20 states have their own specific doctor shopping policies that prohibit patients from knowingly withholding information from their practitioner about controlled substances or prescriptions they have received from another provider. In California, doctor shopping laws follow the Uniform Narcotic Drug Act, which criminalizes obtaining controlled substances through concealing material facts or deceit.
Laws about doctor shopping vary by state and regulations about controlled substances can change. In some states, there are laws that specify information communicated from patient to practitioner in an attempt to obtain drugs by fraud cannot be protected as privileged communication.
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Ethics
For clinicians, there is an ethical challenge in balancing access and safety. Many people need controlled medications for legitimate reasons. At the same time, prescribers and pharmacists have responsibilities to ensure prescriptions are issued for legitimate medical purposes.
In fact, pharmacists hold a large responsibility in preventing doctor shopping. They have to watch for fake prescriptions, look out for altered prescriptions and be aware of patients with several prescriptions from multiple physicians.
Prescription drug monitoring programs called PDMPs have also been critical in the prevention of doctor shopping and the rise in addiction to narcotics. They help clinicians review controlled substance prescription histories. They require doctors and pharmacists to record each prescription filled in a government database. It helps identify risky combinations, overlapping prescriptions and high-risk patterns of use.
What are the most commonly sought-after drugs?
In a 2010 study published in the journal Drug and Alcohol Dependence, researchers found that opioids accounted for an estimated 12.8% of all prescriptions involved in doctor shopping. Benzos were the next most sought-after drug, followed by prescription stimulants.
Other sought-after drugs:
- Anabolic steroids like Anadrol and Depo Testosterone
- Central nervous system depressants like Xanax or Klonopin
- Hallucinogens like Ketalar
- Prescription pain medications like OxyContin and Vicodin
- Prescription stimulants like Desoxyn or Concerta
How can healthcare providers address Doctor Shopping?
Healthcare teams can help reduce doctor shopping without creating a hostile environment for patients with legitimate needs. The best systems will combine clear policies that include empathy, what patients know to expect and a consistent process for responding to risks.
- Checking PDMP data according to clinical guidance and state requirements
- Setting refill expectations in writing, including policies for early refills and lost medication
- Screening for substance use disorder, mental health conditions and suicide risks when concerns arise
- Coordinate with pharmacies, specialists and behavioral health providers
- Offer or refer for evidence-based treatments when addiction is suspected
Reach out to Hotel California by the Sea
We specialize in treating addiction and other co-occurring disorders, such as PTSD. Our Admissions specialists are available to walk you through the best options for treating your addiction.
Do you suspect someone of having a Substance Use Disorder?
Recognizing that doctor shopping may be a sign of deception, poor care coordination or addiction can help negate a higher risk in the healthcare system. Substance use disorders can occur for many reasons and doctor shopping may be a behavioral sign that there is something wrong.
Professional behavioral health programs like Hotel California by the Sea, provide treatment for all types of substance use disorders. We offer treatment at all levels of care including detox, residential, PHP and IOP. We utilize evidence-based methods such as CBT, DBT and EMDR therapy. Hotel California by the Sea is dedicated to helping clients reach their goals in sobriety and overcome their addiction.
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC3552465
https://www.cdc.gov/phlp/docs/menu-shoppinglaws.pdf
https://www.addictioncenter.com/addiction/doctor-shopping
https://rehabs.com/blog/heres-what-you-need-to-know-about-doctor-shopping
https://www.drugrehab.com/addiction/prescription-drugs/doctor-shopping
