MedicalResearch.com Interview with:
Kao-Ping Chua, M.D., Ph.D.
Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan, Ann Arbor
MedicalResearch.com: What is the background for this study?
Response: Doctor and pharmacy shopping is a high-risk behavior in which patients obtain opioid prescriptions from multiple prescribers and fill them at multiple pharmacies. Because this behavior is associated with a high risk of overdose death, there have been many efforts to help clinicians detect doctor and pharmacy shopping among patients prescribed opioids. For example, 49 states have a prescription drug monitoring program that provides information on patients’ prior controlled substance prescriptions.
In contrast, there has been little attention to the possibility that patients prescribed opioids may have family members who are engaged in opioid doctor and pharmacy shopping. Such family members may divert opioids prescribed to patients because of their access to these opioids.
MedicalResearch.com: What are the main findings?
Response: In this study, we examined 1.4 million opioid prescriptions in 2016 from 554,000 privately insured individuals enrolled in family insurance plans. For each of the 1.4 million opioid prescriptions for patients, we determined whether at least one of their family members met criteria for doctor and pharmacy shopping, defined as filling opioid prescriptions from 4 or more pharmacies and 4 or more pharmacies in the 12 months prior to the patient’s opioid prescription.
We found that 0.6% (1 out of 167) of opioid prescriptions were filled by patients at the time a family member met these criteria. Given that there were 210 million opioid prescriptions filled at U.S. pharmacies in 2016, we estimate that 1.2 million opioid prescriptions were at high risk of being diverted by family members engaged in doctor and pharmacy shopping.
MedicalResearch.com: What should readers take away from your report?
Response: The most important take-away is that clinicians should decrease the amount of opioid available for diversion by family members by avoiding unnecessary or excessive opioid prescribing.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: It’s important to understand that 0.6% is likely an underestimate, in part because we focused on privately insured patients, who are known to have lower rates of doctor and pharmacy shopping behavior than publicly insured patients. In light of this, it will be important to repeat this study in publicly insured patients.
I don’t have any disclosures. Conflicts of interest for my co-authors are listed on the published manuscript at this link:
Chua K, Brummett CM, Conti RM, Haffajee RL, Prosser LA, Bohnert AS. Assessment of Prescriber and Pharmacy Shopping Among the Family Members of Patients Prescribed Opioids. JAMA Netw Open.2019;2(5):e193673. doi:10.1001/jamanetworkopen.2019.3673
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