The ongoing opioid epidemic in America has hit an all-time high, with more than 2.1 million people in the U.S. suffering from prescription pain reliever use disorders. More than 78 opioid-related deaths occur in the country every day. California is experiencing a more rampant problem than other states, with some counties reporting death rates three times higher than the national average. More than 4,000 Californians die from opioid addictions every year. One major contributor to prescription opioid misuse, abuse, and overdose is doctor shopping.
What Is Doctor Shopping?
“Doctor shopping” describes the practice of visiting multiple physicians and obtaining prescriptions from each of them for drugs that are otherwise illegal. A doctor shopper may, for example, visit more than one physician complaining of chronic back pain and receive multiple prescriptions for pain relieving opioids such as hydrocodone or oxycodone. The drug shopper is then able to take more than the prescribed amount of the painkiller to feed an addiction, or sell the drugs to others on the black market.
In many cases, doctor shopping stems from a patient’s legitimate pain. Opioids such as prescription painkillers and heroin are highly addictive. A patient who is unaware of the risks of addiction may not use the drug with caution – continuing the vicious cycle. Someone suffering an injury or disorder may have acquired a prescription for opioids legally, and then developed a substance abuse problem over time. Eventually, this patient may resort to doctor shopping to avoid withdrawal.
Doctor shopping is a form of prescription fraud that perpetuates the opioid epidemic throughout America. Prescription fraud can take the shape of forging or altering a prescription, obtaining real prescriptions from criminal physicians, faking symptoms to obtain a prescription, or buying drugs health care facility personnel illegally sell. Many physicians are too afraid of making false accusations to confront a patient about doctor shopping. Thus, researchers largely underestimate the scale of this issue and many cases remain undiagnosed.
The Beginning Of The End Of Doctor Shopping
Opioids negatively impact millions of lives, leading to broken families, overdose deaths, and tragedies. One such tragedy struck the Pack family in 2003 when a driver using Vicodin, alcohol, and muscle relaxants struck and killed their two young children on a sidewalk near their home in Danville, California. The driver, a doctor shopper, had prescriptions for the drug from six different Kaiser Permanente doctors. Thirteen years after this tragedy, California is passing a law that could reduce doctor shopping for good.
On Tuesday, September 27, Governor Jerry Brown signed Senate Bill 482 into law amid an intense national focus on prescription and illegal opioid epidemic across America. Data from the U.S. Centers for Disease Control and Prevention (CDC) show that over 165,000 people in the country died from prescription opioid overdoses between 1999 and 2014. California has an especially rampant opioid problem, with close to 4,400 opioid overdose deaths throughout the state in 2014. The passing of Senate Bill 482 has the power to drastically reduce the ability of opioid addicts to doctor shop – ideally leading to a lower drug-related death toll.
Once this Bill goes into effect on January 1, 2017, it will require doctors and health care professionals to check a database and review a patient’s prescription history before they can prescribe opioids and other dangerous drugs. Twenty-four other states have already passed similar laws, making it mandatory for doctors to check state-based monitoring systems before issuing prescriptions. After one year with their new law, New York reported a 75% drop in doctor shopping for opiates. Lawmakers hope to see a similar drop in California thanks to the Bill.
History Of Prescription Record Databases
Doctors have had the ability to check the prescription database since the start of California’s Controlled Substance Utilization Review and Evaluation System (CURES) since 2009, but it has been optional for doctors, nurses, dentists, and others who issue prescriptions. Until Senate Bill 482, most physicians have not taken advantage of the technology. Advocates of the Bill, including the Pack family, realize this problem and understand the importance of making it mandatory to truly reduce doctor shopping.
Even with the passing of the Bill, there is no guarantee that doctors will check the database before writing prescriptions. However, doctors who do not comply will face administrative discipline from the California Medical Board. The potential consequences should encourage many more doctors to check CURES before issuing prescriptions. For advocates, Senate Bill 482 is at least a step in the right direction.
Details Of California Senate Bill 482
Senate Bill 482, authored by Democratic Senator Ricardo Lara, requires any health care practitioner with authorization to prescribe, administer, order, and furnish controlled substances to check the CURES database. The health care practitioner must consult CURES to review a patient’s prescription and controlled substance history no sooner than 24 hours (or the previous business day) before prescribing certain controlled substances – Schedule II, III, or IV. These designations outline narcotics with a high potential for abuse and/or physical or psychological dependence, such as:
- Alprazolam (Xanax)
- Diazepam (Valium)
The list of risky drugs also includes sleep aids, steroids, and psychiatric medications. Before prescribing or administering any of these drugs to patients, health care practitioners in California must now consult CURES and review the patient’s drug history. If the practitioner sees any signs of drug abuse, dependency issues, or doctor shopping on the patient’s record, he or she can refuse to prescribe the medication.
For as long as the patient continues treatment with the drug, the health care practitioner must review the database every four months. It will be up to medical boards across the state to enforce the law. Senate Bill 482 strives to put an end to doctor shopping and intervene when patients are at risk of harm from substance misuse and abuse. The passing of this Bill is a positive step toward helping California and the rest of the nation of harmful opioid addictions.
Bill Support And Opposition
Senate Bill 482 passed with 28 California State Senators supporting it and 11 opposing the motion. Supporters of the Bill include family members of people who have died because of substance abuse problems, the California Narcotics Officers’ Association, Consumer Watchdog and several other consumer groups, the California College, and the University Police Chiefs Association. Advocates believe that something as simple as checking a patient’s prescription history can give health care professionals necessary information to intervene when they see signs of drug abuse.
Although California health care facilities have maintained patient records of narcotic prescriptions for years – first on paper and then with CURES – for more than 20 years, the powerful doctors’ lobby fought against efforts to make patient prescription history reviews mandatory. A move by California state lawmakers this year gave additional funding to modernize the program, widely putting an end to health association disapproval.
Opponents of the Bill include Rite Aid and CVS Health, as well as the California Medical Association (CMA). In a statement, the CMA described the mandatory CURES check as “premature” and “overly broad,” believing it would negatively impact patient care. The CMA stated that Senate Bill 482 would discourage the prescribing of controlled substances even for patients who legitimately need them. Now that the bill has passed the state Assembly, only time will tell what the true outcome of Senate Bill 482 will be on Californians.
What You Can Do To Prevent Doctor Shopping
Many different organizations and coalitions believe the rising opioid problem is due to a lack of prescription drug education, especially in young adults. Spreading awareness of the risks of prescription pain relievers and practices such as doctor shopping can potentially reduce the number of opioid addicts. Targeting anti-drug efforts toward America’s youth is one way the U.S. can hope to reduce its opioid death toll in the future. In the meantime, Senate Bill 482 will help prevent doctor shoppers from getting away with prescription fraud.
It is the job of physicians to review the CDC’s prescribing guidelines as well as information from the California Medical Board. When appropriate, they should consider recommending non-pharmacologic therapies such as behavioral or cognitive therapies instead of opioids. Ensure patients understand the risks of taking opioids, and screen them for past issues that could increase the chance of addiction.
What Patients Can Do
As a patient, ask your physician if there are alternative pain management methods to prescription pain relievers. If you must take these drugs, fully understand the side effects and risks of addiction and misuse. If you’re taking opioids at home, also ask for prescription naloxone to prevent an overdose. Naloxone could save your life. If you know someone who is guilty of doctor shopping, report him or her to the authorities. Being smart about prescription drugs and doing everything in your power to prevent misuse can help the future generations beat addiction once and for all.