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Addressing “Doctor Shopping” Among the Patient Population

For physicians who practice in Central Kentucky, particularly those who prescribe pain medication on a regular basis, it’s no secret that addiction to prescription drugs is a very real and dangerous problem in Central Kentucky. According to the Centers for Disease Control and Prevention, for every 100 people in the state of Kentucky, there are 96 to 143 pain medication prescriptions, a sign that there are patients who receive multiple prescriptions for their pain medication.

brent_j_morris_md_lexclinic_kydocspring15To raise even more awareness of this issue, and the problems that can occur within the medical community because of prescription addiction, Brent J. Morris, M.D., Lexington Clinic orthopedic surgeon, highlighted the prevalence of “doctor shopping” and pain medication abuse in a study he published alongside four other physicians. The study, titled “Narcotic Use and Postoperative Doctor Shopping in the Orthopaedic Trauma Population,” focused on ‘doctor shopping,’ particularly among patients who underwent orthopedic surgery. Doctor shopping occurs when a patient visits multiple physicians for the same medical problem and each physician fills a prescription for pain medication. As a result, the patient ends up with an abundance of these dangerous drugs, and their chances of becoming addicted to the medication increases dramatically.

“In our study, we found that one in five patients who had orthopedic surgery after traumatic injuries will ‘doctor shop’ for prescription drugs following their procedure and this behavior is more likely to occur in patients with pre-injury pain medication use,” said Dr. Morris. “With this research, we hope to make it easier for physicians to identify the patients who would be most likely to demonstrate this doctor shopping behavior. Once identified, it becomes much easier for physicians to engage patients in conversation about the dangers of having too much pain medication available.”

Of all states, Kentucky has the third highest death rate due to prescription drug overdose, averaging more than 1,000 deaths per year. These statistics are the reason that prescription tracking programs, such as KASPER – the Kentucky All Schedule Prescription Electronic Reporting, the nation’s first such program, are in place. This program tracks a specific prescription each time it is filled, and allows physicians and pharmacists to see where, and when, it was filled. The goal is to reduce ‘doctor shopping’ by eliminating the patient’s ability to fill a prescription multiple times. However, solutions to end this addiction problem should go beyond preventative programs. Prevention should extend to the prescribing physician as well.

“Good communication is key. We need to increase awareness so we can better counsel and treat the at-risk patients. Additionally, we should look at the patient’s history for red flags, such as a lower level of education and history of using prescription narcotics, and prescribe these pain medications with great care and vigilance to minimize the risk of abuse, dependence and other narcotic-related adverse events,” said Dr. Morris.

Dr. Morris added that, even though physicians need to make the patient aware of how easy it is to become addicted to these pain medications, they need to be sure the patient knows they are doing all they can to ensure proper pain management after surgery as well.

“That’s the other side of the coin. Pain control is a very important part of care, particularly care following surgery. As physicians, it is important to make sure patients know we are doing all we can to make their healing process as comfortable and pain-free as possible,” said Dr. Morris. “However, patients also need to use pain medications responsibly and they should not seek pain medications from multiple physicians. Most importantly, a level of trust between patients and physicians should be established in order to create the best plan, with the lowest risk for addiction possible when discussing treatment and follow-up plans.”

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