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An analysis of the number of multiple prescribers for opioids utilizing data from the California Prescription Monitoring Program

Authors

  • Barth L. Wilsey,

    Clinical Professor of Anesthesiology, Corresponding author
    1. Department of Anesthesiology and Pain Medicine, UC Davis Medical Center, Sacramento, CA, USA
    • VA Northern California Health Care System, Sacramento, CA, USA
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  • Scott M. Fishman,

    Professor and Chief, Division of Pain Medicine
    1. Department of Anesthesiology and Pain Medicine, UC Davis Medical Center, Sacramento, CA, USA
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  • Aaron M. Gilson,

    1. Pain & Policy Studies Group, Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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  • Carlos Casamalhuapa,

    Applications Programmer
    1. Clinical and Translational Science Center (CTSC), UC Davis Health System, Sacramento, CA, USA
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    • Present Position: University of Utah School of Medicine.
  • Hassan Baxi,

    Applications Programmer
    1. Clinical and Translational Science Center (CTSC), UC Davis Health System, Sacramento, CA, USA
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  • Tzu-Chun Lin,

    1. Department of Statistics, University of California, Davis, Davis, CA, USA
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  • Chin-Shang Li

    1. Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Davis, CA, USA
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  • This article was published online on March 29, 2011. Error was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected [June 29, 2011].

Barth L. Wilsey, MD, Pain Academic Office, UC Davis Medical Center, 3020 Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA, USA 95817.

E-mail: blwilsey@ucdavis.edu

ABSTRACT

Background

Prescription monitoring programs scrutinize the prescribing of controlled substances to diminish the utilization of multiple prescribers (aka. “doctor shopping”). The use of multiple prescribers is not a problem per se and can be legitimate, as when the patient's regular physician is not available or a concurrent painful condition is being cared for by a different practitioner.

Purpose

The primary objective of this study was to determine if those patients who used a few prescribers (two to five) in a 1-year period were distinguishable from those who used only one prescriber.

Methods

We performed a secondary data analysis of the California Prescription Monitoring Program, the Controlled Substance Utilization Review and Evaluation System, by using data collected during 1999–2007.

Results

The group who used a few providers (two to five) differed substantially from those who visited one provider over a 1-year period. However, the dissimilarity did not suggest that these patients were more prone to the abuse of opioids.

Conclusions

The decision not to investigate patients who visit a low number of multiple prescribers (two to five) appears to be justifiable. If the number of providers in a given period of time is used to determine if a patient should be challenged as being a “doctor shopper,” cutoffs with high specificity (low false-positive rates) should be chosen. Further epidemiologic research is needed to determine the association of the number of prescribers and misuse and/or abuse of opioids. Copyright © 2011 John Wiley & Sons, Ltd.

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