Doctor Shopping And The Opioid Epidemic

Doctor shopping is defined as seeking multiple treatment providers, either during an illness episode or to obtain prescription medications illegally.

People who are prescribed prescription opioids and develop opioid use disorder (OUD) may doctor shop to ensure their supply.

This has been a significant contributing factor to the opioid epidemic.

Drugs commonly sought while doctor shopping include:

• prescription pain medications (opioids)
• painkillers such as oxycodone, OxyContin, hydrocodone, and Vicodin
• benzodiazepines such as Xanax
• methadone (when obtained outside of a licensed opioid treatment program)

Prescription drug misuse and lying to obtain multiple prescriptions for controlled substances is considered prescription fraud and is illegal both federally and at the state level.

How Often Do People Doctor Shop?

Rates of doctor shopping vary from state to state within the United States.

Due to the prescribing law differences in each state, the rate of doctor shopping in the U.S. ranges from a little more than six percent up to 53 percent.

This significant difference is also in part due to the different definitions of doctor shopping.

Healthcare providers do what they can to help each patient but, in some cases, a prescription may not be given.

Common Reasons For Doctor Shopping

There are many reasons someone may choose to participate in doctor shopping.

Opioids are frequently prescribed for legitimate pain management. For some people, opioid use disorder can develop even when medications are taken as prescribed, due to a combination of physiological, genetic, and environmental factors.

A few reasons doctor shoppers commonly give to explain their behavior include:

• inconvenient office hours/location
• long wait times (in-office)
• disliking the healthcare practitioner’s personality
• insufficient communication between the patient and clinician
• persistent symptoms
• nonacceptance of the diagnosis
• seeking prescription drugs for recreational use
• seeking relief beyond what a single provider will prescribe, including for undertreated pain or self-medication of other conditions

Doctor Shopping Within Families

A 2016 study from the University of Michigan looked at more than 554,000 privately insured individuals and any relatives also covered under the same plan.

This study specifically looked at individuals who had received opioid prescriptions from four or more prescribers and filled them at four or more pharmacies over the past year.

Since 2016, overall opioid prescribing rates have declined significantly, which has reduced, though not eliminated, the scale of doctor shopping.

How Is Doctor Shopping Worsening The Opioid Epidemic?

Doctor shopping increases the number of opioid medications accessible for misuse and illegal use.

This, in turn, worsens the opioid epidemic because it increases the likelihood that someone without a prescription will have access to and freely misuse the substance.

While doctor shopping for prescription opioids remains a concern, the current opioid crisis is now primarily driven by illicitly manufactured fentanyl rather than diverted prescription drugs.

What Is Being Done To Stop Doctor Shopping?

Some measures are being taken to prevent doctor shopping, including:

• healthcare professionals reviewing insurance records
• prescription drug monitoring programs (now operating in all 50 states)
• increased opioid prescribing education for law enforcement

Updated Opioid Prescribing Guidelines Have Reduced Overprescribing

In 2022, the CDC updated its Clinical Practice Guideline for Prescribing Opioids, replacing the controversial 2016 version.

The updated guidelines give providers more flexibility to treat legitimate pain while emphasizing caution around high doses and long-term prescribing. Key changes include guidance on starting at the lowest effective dose, reassessing patients frequently, and discussing the risks of opioid use disorder before prescribing.

These guidelines have contributed to a significant decline in overall opioid prescribing. According to the CDC, the total number of opioid prescriptions dispensed in the U.S. has fallen sharply from its peak of over 255 million in 2012.

While this has helped reduce one pathway to opioid misuse, it has also raised concerns about undertreated pain. It also underscores the importance of individualized care rather than rigid prescribing limits.

Doctor Shopping Laws In The United States

Over the past several decades, each state has introduced its own doctor shopping laws, building on the federal Uniform Controlled Substances Act of 1970.

States with general doctor shopping laws prohibit the patient from getting drugs through any of the following means:

• fraud
• deceit
• misrepresentation
• subterfuge
• concealment of a material fact

Drug laws vary, depending on the state. Some states have put in place general doctor shopping laws, while others have instituted more specific drug laws.

Examples Of Drug Laws By State

The drug laws in California, for example, contain language from the Uniform Narcotic Drug Act that states no person shall obtain controlled substances, or administer them illegally.

On the other hand, states like Kentucky have general drug laws which simply state that knowingly obtaining controlled substances is illegal.

Do Prescription Drug Monitoring Programs (PDMPs) Help?

Prescription Drug Monitoring Programs collect data about controlled substances such as opioids from in-state pharmacists and mail-order pharmacies that ship prescriptions.

Prescription opioid use disorder is a serious issue in the U.S., but help is available.

A remaining challenge is interoperability between state PDMP systems: a patient who doctor shops across state lines may not be flagged if those states’ databases don’t communicate. Efforts to improve interstate data sharing have expanded in recent years but remain incomplete.

Some clinicians have raised concerns that PDMP flags can result in undertreating patients with legitimate pain needs or may discourage people from seeking care.

Finding The Best Prescription Drug Treatment For You

If you or a loved one has experienced doctor shopping due to uncontrolled drug use, it may be time to seek help.

Contact our substance use disorder treatment helpline today for a free addiction assessment and professional advice on finding an addiction treatment program that works for your situation.

Written by the Addiction Resource Editorial Staff