Double Dippers

Doctor Shopping Common among Trauma Patients

NEIL WEBB/THE ISPOT

 

“Doctor shopping,” or going to multiple doctors for narcotic prescriptions, is prevalent among more than 20 percent of orthopedic trauma patients, according to a Vanderbilt study released at a recent meeting of the American Academy of Orthopaedic Surgeons. The study, which included 151 adult patients admitted to Vanderbilt for isolated fractures in 2011, used Tennessee’s Controlled Substance Monitoring Database to compare patients with a single narcotic provider to those found to have multiple narcotic providers.

Patients who did doctor-shop received, on average, more prescriptions (seven) and took more medication daily for a longer duration (110 days) compared with patients with a single provider, who averaged two prescriptions with a lower daily amount for a total of 28 days.

“I knew it would be a significant number, but I didn’t expect to find that one of every five patients who walked into my office was also getting narcotics from somewhere else,” says senior author Dr. Hassan Mir, assistant professor of orthopaedic surgery and rehabilitation.

“Our intent is to control their pain. I tell all my patients, ‘I don’t want you to hurt; I want to control your pain. I just want to do it in a responsible way so you don’t become addicted or have so much of this medication lying around that it may fall into the wrong hands.’”

Mir says he was not totally surprised by the study results, considering that Americans comprise less than 5 percent of the world’s population yet consume 99 percent of the global hydrocodone supply and 80 percent of the global opioid supply. Prescription narcotic overdose deaths in the United States have tripled during the past decade, he adds.

He also doesn’t believe the majority of patients using multiple doctors were seeking other providers because their pain wasn’t controlled. “I don’t necessarily think that is the case because, when you look internationally at how many narcotics are used, we use far more narcotics than any other nation on earth, and I don’t think people in different countries hurt less than we hurt,” he says.

“I think we somehow must start to manage expectations a little bit better. I have done international work where people are happy with a Tylenol, versus here where they need high-dose narcotics—and it just doesn’t add up for the same injury.”

Patients in the study with less than a high-school education were 3.2 times more likely to seek multiple providers, and patients with a history of preoperative narcotic use were 4.5 times more likely to seek multiple providers.

“We wanted to find out exactly how many patients are getting narcotics from multiple places because, now, we are required to look in the database before we give them prescriptions,” says Mir. “This has led to some uncomfortable conversations in which we have had to confront patients and try to resolve the problem.”

Mir conducted the study with lead author Dr. Brent Morris, Dr. Justin Zumsteg, Kristin Archer and Brian Cash.