Doctor Shopping Was Common After Bone Surgery

More than 1 in 5 orthopedic patients sought narcotics from other providers

(RxWiki News) After orthopedic surgery, many patients return to their doctor asking for more pain medication. But many find other doctors in addition to their own who will prescribe them more narcotics.

Doctor shopping (the practice of seeing more than one doctor, usually to get controlled substances) was more common among people taking narcotics before surgery and those who were less educated, the study found.

"Seek medical care if you have addiction problems."

Brent Morris, MD, of Vanderbilt University in Nashville, TN, conducted the study with colleagues.

The researchers included patients admitted to a single trauma center for orthopedic surgery in 2011. They identified 130 patients. These patients were entered into a state-controlled substance monitoring database. This database had data on who used narcotics before and after surgery. It also told how much medication was prescribed.

The study authors found that 20.8 percent of the patients (27 of 130) sought more than one doctor to give them narcotics after surgery.

Those with a high school education or less were 3.2 times more likely to doctor shop than more educated people, the researchers found.

Patients who had three or more prescriptions for narcotics within three months prior to going into the hospital were 4.5 times more likely to doctor shop after surgery than patients who had not used narcotics before surgery, the authors found.

The researchers found that, overall, people who doctor shopped used more narcotics for a longer period of time than patients who only asked for pain relief from their own doctor.

Those who were treated by only their own doctor or others in that office, such as nurse practitioners, averaged two prescriptions for narcotics after their surgery. However, those who went to find other doctors to prescribe medicine for them averaged seven prescriptions.

People who went to their own doctor took a midrange dose of 26 milligrams of a morphine-equivalent of narcotic per day for 28 days. Patients who went to find other providers took a midrange 43 milligrams of a morphine-equivalent dose of medicine daily for 110 days.

The study authors noted they did not know whether people seeking more than one doctor to get narcotics took the medicines themselves or sold them.

Cliff Hamrick, LPC, of Havamal Therapy in Austin, TX, told dailyRx News that this study is relevant to mental health professionals for two main reasons.

"First, we are typically better trained in recognizing substance abuse than most medical doctors," he said. "Second, we often see our clients more often than medical doctors so it is easier for us to notice subtle changes in a client's behavior over time. But, for us to be effective in catching narcotic abuse and doctor shopping early, we must consistently ask our clients about their medication usage and be insistent on clear responses."

In a press release, Dr. Morris noted that there has been an alarming rise in the use of narcotics in the United States. While the primary use of these medications is for pain relief, many are not used for their intended purposes, he said.

He added that this study points out how doctors need to work with patients to control their pain after surgery.

This study was published Aug. 6 in the Journal of Bone and Joint Surgery.

No outside sources funded this study, but one or more of the authors disclosed having a past financial relationship with sources that could be seen as influential in this area of research.

Review Date: 
August 12, 2014