Multiple prescribers in older frequent opioid users--does it mean abuse?

BACKGROUND: Obtaining analgesic narcotics from multiple prescribers is sometimes called 'doctor-shopping,' implying abuse. If the use of multiple prescribers can be used as an indicator for abuse, it would be a convenient way to study abuse in large populations.

OBJECTIVE: To assess multiple prescribers as an indicator of abuse by relating quantity of opioids obtained by older Norwegians to number of prescribers.

METHODS: Data were obtained from the Norwegian Prescription database which includes all prescriptions filled in Norwegian pharmacies. The study population consisted of people aged 70-89 who filled five or more prescriptions for weak or for strong opioids in 2008.

RESULTS: In 2008, 4,268 persons filled five or more prescriptions for strong opioids and 19,675 for weak opioids. More than 30% had three or more prescribers. Over half of strong opioids users and 72% of weak opioid users had medication-use-periods of over 40 weeks. For strong opioids, increasing DDDs/week was found with increasing number of prescribers. When cancer/palliative care patients were excluded, the mean DDDs/week level for strong opioids was much lower, and little association with number of prescribers remained. For weak opioids, little association between mean DDDs/week and number of prescribers was found.

CONCLUSIONS: This study demonstrated that the increasing quantities of strong opioids with increasing number of prescribers are largely due to treatment of cancer/palliative care patients. While the use of multiple prescribers can be a red flag for problematic medication use, it cannot be considered synonymous with 'doctor-shopping' or abuse.