The association between doctor and pharmacy shopping and self-reported misuse and abuse of prescription opioids: A survey study

Abstract

Background/Rationale: Little is known about the reasons for visiting multiple doctors/ pharmacies, known as doctor/pharmacy shopping, to obtain opioids. Objective: To investigate patients’ self-reported reasons for doctor/pharmacy shopping and assess whether doctor/pharmacy shopping behavior can be used as a surrogate measure of opioid abuse/misuse. Methods: We conducted a cross-sectional web-based survey among adult patients with ≥2 pharmacy claims for immediate-release or extended-release/long-acting opioids between 7/1/ 2015 and 12/31/2016, identified from a large United States (US) commercial claims data-base. Patients were classified into no, mild, moderate, or severe shopping categories based on their claims. Reasons for doctor/pharmacy shopping and opioid abuse/misuse were deter-mined from patient responses to the Prescription Opioid Misuse and Abuse Questionnaire. Results: A random sample of 10,081 patients was invited to participate in the survey and 1085 (11%) completed surveys. The most frequently reported reasons for doctor/pharmacy shopping were convenience, availability, price, and multiple morbidities requiring pain management. Among patients in the no, minimal, moderate, and severe shopping categories, only 7.8%, 8.5%, 11.8% and 12.6% reported opioid abuse/misuse, respectively. Conclusion: In this commercially-insured population, patient-reported reasons for doctor/ pharmacy shopping do not suggest opioid abuse/misuse. Less than 15% of patients with shopping behavior in the past 3 months reported any reasons attributable to opioid abuse/ misuse, indicating that shopping behavior in this population may not be a good surrogate for abuse/misuse.