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Medical record-based ascertainment of behaviors suggestive of opioid misuse, diversion, abuse, and/or addiction among individuals showing evidence of doctor/pharmacy shopping

Authors Esposito DB, Cepeda MS, Lyons JG, Yin R, Lanes S

Received 30 January 2019

Accepted for publication 24 May 2019

Published 24 July 2019 Volume 2019:12 Pages 2291—2303


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon

Daina B Esposito,1 M Soledad Cepeda,2 Jennifer G Lyons,1 Ruihua Yin,1 Stephan Lanes1

On behalf of The Members of the Opioid Post-Marketing Consortium Observational Studies Working Group

1Department of Safety and Epidemiology, HealthCore, Inc, Wilmington, DE, USA; 2Department of Research and Development, Janssen, Titusville, NJ, USA

Objectives: Doctor/pharmacy shopping, the practice of seeking prescriptions from multiple healthcare sources without their coordination, may be a measure of prescription medicine abuse. This cross-sectional study examined the relationship between a claims-based doctor/pharmacy shopping definition and medical record documented behaviors suggestive of misuse, diversion, abuse and/or addiction.
Methods: Patients with ≥2 opioid dispensings starting in 2012 in a US administrative claims database were grouped into doctor/pharmacy shopping categories by number of providers and pharmacies used over 18 months: no shopping, minimal shopping, moderate shopping and severe shopping. Medical charts of opioid prescribers were reviewed to identify behaviors suggestive of misuse, diversion, abuse and/or addiction.
Results: Among 581,940 opioid users, 78% were classified as no shopping, 11% minimal shopping, 8% moderate shopping and 3% severe shopping. Almost 40% of severe shopping patients had no medical record documented behaviors (positive predictive value: 24.3%). Compared with no shopping, the odds ratio [OR] of ≥3 behaviors was 1.70 (95% confidence interval [CI] 0.50–5.78) for minimal shopping, 1.81 (95% CI 0.54–6.03) for moderate shopping, and 8.93 (95% CI 3.12–25.54) for severe shopping.
Conclusions: Claims-identified severe doctor/pharmacy shopping was strongly associated with behaviors suggestive of misuse, diversion, abuse and/or addiction, but the proportion of medical records documenting these was low.

Keywords: opioid, doctor/pharmacy shopping, abuse, misuse, addiction

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