Academic journal article Research and Theory for Nursing Practice

Doctor Shopping: A Concept Analysis

Academic journal article Research and Theory for Nursing Practice

Doctor Shopping: A Concept Analysis

Article excerpt

Prescription drug abuse is a significant problem in the United States that poses a serious health risk to Americans and is therefore significant to the field of nursing. The prescription drugs that are designated in the United States as having abuse potential are called controlled or scheduled drugs. The most common types of abused prescription drugs are benzodiazepines prescribed for anxiety, opioids prescribed for pain, and stimulants prescribed for attention deficit disorder. These prescription drugs are abused by taking larger doses than prescribed for nonmedical use to achieve a high or euphoric feeling, or are sold illicitly for profit. In 2009, there were 2.4 million nonmedical users of prescription opioids in the United States. These prescription drugs are often obtained by seeing multiple prescribers, often under false pretenses or with complicity from the prescribers that leads to abuse and illicit sales. The term doctor shopping has been used not only to refer to this phenomenon but has also had other meanings throughout the past decades. Thus, concept analysis is the focus of this article for clarification using the Walker and Avant method. Health implications and suggestions for minimizing doctor shopping are included.

Keywords: doctor shopping; prescription drug abuse; prescribers; addiction; substance

A recent report by the U.S. Government Accountability Office (U.S. GAO; 2011) found that in 2008, 170,000 Medicare beneficiaries received prescriptions from five or more medical practitioners for controlled substances at a cost of $148 million. In 2008, 65,000 Medicaid recipients from four states visited six or more doctors to obtain 10 of the most frequently abused prescription drugs at a cost of $63 million (Civic Federation, 2009). In France, Pradel et al. (2010) studied doctor shopping among patients receiving benzodiazepines (a controlled drug prescribed for anxiety) and found that the overall doctor shopping rate was 3.6% involving 361,428 daily doses. According to the Department of Justice, doctor shopping is the primary method to obtain addictive opioids for illegitimate use (U.S. GAO, 2011).

Doctor shopping is a term used to describe the occurrence of patients receiving medications from multiple providers (Wang & Christo, 2009). Patients who engage in doctor shopping visit more than one prescriber to obtain controlled drugs and do not tell the prescribers that they have been obtaining prescriptions for the same or other controlled drug from other prescribers. In the United States, professionals who have legal authority to prescribe medication include doctors, dentists, and advanced practice nurses (APNs). For this article, these professionals will be called prescribers. The term prescriber is used in government reports related to doctor shopping (Barthwell, Barnes, Leopold, & Wichelecki, 2009). Therefore, the term doctor shopping is attributed not only to patients visiting doctors but also to patients visiting any health care professional who prescribes medication. The term doctor shopping is becoming well-known among medical, legal, and law enforcement professionals and the public, despite the fact that it applies not just to doctors but to multiple health professionals who prescribe medications as well. There is no clear consensus on what constitutes doctor shopping, and, in some instances, the term has been applied to other meanings. A literature review reveals that prior analysis and development of the concept has not been done.

EXTANT DEFINITION

There are three aspects of doctor shopping that are currently accepted: (a) obtaining more than one controlled prescription drug from more than one prescriber and pharmacy within a certain time frame, (b) the patient does not tell their prescribers they have previously been prescribed a controlled drug by another prescriber, and (c) visiting several prescribers within a specified time period, usually 1 year to obtain prescriptions for illicit use. …

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