Qyestion: What is a prescriber’s legal obligation if he or she suspects “doctor shopping”?
Answer: Doctor shopping is a national concern, raising issues of both individual and public health safety. Many states have laws prohibiting doctor shopping (or similar conduct designed to obtain controlled medications, sometimes described as giving false information or omitting material information). Prescribers should contact their state licensing board to learn about their state’s position.
Some states may require the practitioner to report the discovery of a doctor shopper; others may not. Some states may limit the definition of doctor shopping to a particular window of time, for example, the past 30 days—others may not but may view doctor shopping in a wider context, allowing a doctor to report suspected doctor shopping at any time. Finally, many states spell out allowed and prohibited conduct with respect to the use of prescription drug monitoring program materials in the context of suspected doctor shopping.
Practitioners should take time to review monitoring database laws, as they often are intended to identify doctor shoppers and thus supply a road map for practitioners to follow if such conduct is suspected. If the practitioner is unsure of what the laws in his of her state allow or disallow regarding doctor shopping, the practitioner should seek input from experienced legal counsel.
At a minimum, the practitioner should contact the help desk associated with the state agency given primary jurisdiction over the monitoring database. Doctor shopping can mean many things, and practitioners must always remember that they are first to do no harm to their patients and second to act in accordance with laws and regulations that protect the public health and safety. Whether we agree with these laws or not, they exist, and it is important to understand and follow them in good faith.
—Jennifer Bolen, JD
J. Bolen Group, LLC
Answer: Doctor shopping usually refers to a situation in which a patient who is being prescribed a controlled drug necessary for the legitimate treatment of his or her current medical condition goes to other physicians to obtain more of the same or similar medication, usually without revealing the relationship with the first physician. If you learn of such behavior, Ms. Bolen has explained the need to find out what your state’s reporting regulations are and act on them.
The other question is, how will this affect your relationship with your patient? As I see it, if the patient has previously signed an agreement that states that I am the only prescriber from whom he or she will receive opioids (as is typical when prescribing opioids for chronic pain), then he or she has broken the agreement between us.
My first step is to investigate the circumstances. For example, if the patient received an opioid from a dentist after a tooth extraction or went to the emergency room for an unrelated injury and was prescribed pain medication, I remind the patient that in such cases I need to be informed as soon as possible that he or she has received the prescription. (Note: Taking an opioid for chronic pain will not prevent a person from experiencing a supervening acute pain, as from injury or surgery, so he or she will indeed likely require additional pain medication.)
If, however, the patient has repeatedly obtained an opioid from another prescriber, then I explain that the trust between us has been broken. The patient has repeatedly lied to me (at least by omission), and lying to me is a sure way to get discharged.
A patient who receives opioids for chronic pain is very likely to become physically dependent on the drug and should therefore generally be tapered rather than cut off if the health professional is no longer willing to prescribe. A physician who initiates ongoing opioids for chronic pain needs to have an exit strategy for getting the patient off opioids, preferably in such a way as to avoid withdrawal symptoms.
—Jennifer Schneider, MD, PhD
Internal Medicine, Addiction Medicine, and Pain Management