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The Association Between Doctor and Pharmacy Shopping and Self-Reported Misuse and Abuse of Prescription Opioids: A Survey Study

Authors Stephenson JJ, Cepeda MS, Zhang J, Dinh J, Hall K, Esposito DB, Kern DM

Received 25 September 2019

Accepted for publication 19 February 2020

Published 3 April 2020 Volume 2020:13 Pages 689—701


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael A Überall

Judith J Stephenson,1 M Soledad Cepeda,2 Jie Zhang,3,4 Jade Dinh,4 Kelsey Hall,4 Daina B Esposito,4– 6 David M Kern2

1Scientific Affairs, HealthCore, Inc, Wilmington, DE, USA; 2Epidemiology, Janssen Research and Development, Titusville, NJ, USA; 3Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA; 4Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA; 5Ciconia, Inc, Westford, MA, USA; 6Epidemiology, Boston University, Boston, MA, USA

Correspondence: Judith J Stephenson
HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE 19801, USA
Tel +1 302-230-2142

Background/Rationale: Little is known about the reasons for visiting multiple doctors/pharmacies, known as doctor/pharmacy shopping, to obtain opioids.
Objective: To investigate patients’ self-reported reasons for doctor/pharmacy shopping and assess whether doctor/pharmacy shopping behavior can be used as a surrogate measure of opioid abuse/misuse.
Methods: We conducted a cross-sectional web-based survey among adult patients with ≥ 2 pharmacy claims for immediate-release or extended-release/long-acting opioids between 7/1/2015 and 12/31/2016, identified from a large United States (US) commercial claims database. Patients were classified into no, mild, moderate, or severe shopping categories based on their claims. Reasons for doctor/pharmacy shopping and opioid abuse/misuse were determined from patient responses to the Prescription Opioid Misuse and Abuse Questionnaire.
Results: A random sample of 10,081 patients was invited to participate in the survey and 1085 (11%) completed surveys. The most frequently reported reasons for doctor/pharmacy shopping were convenience, availability, price, and multiple morbidities requiring pain management. Among patients in the no, minimal, moderate, and severe shopping categories, only 7.8%, 8.5%, 11.8% and 12.6% reported opioid abuse/misuse, respectively.
Conclusion: In this commercially-insured population, patient-reported reasons for doctor/pharmacy shopping do not suggest opioid abuse/misuse. Less than 15% of patients with shopping behavior in the past 3 months reported any reasons attributable to opioid abuse/misuse, indicating that shopping behavior in this population may not be a good surrogate for abuse/misuse.

Keywords: doctor/pharmacy shopping, prescription opioid, abuse and misuse

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