Doctor shopping
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Doctor shopping refers to the practice of a patient requesting care from multiple physicians, often simultaneously, without making efforts to coordinate care or informing the physicians of the multiple caregivers. This usually stems from a patient's addiction to, or reliance on, certain prescription drugs or other medical treatment. Usually a patient will be treated by their normal physician and be prescribed a drug that is necessary for the legitimate treatment of their current medical condition. Once that condition has been successfully treated, however, most conscientious physicians will not continue to provide their patients with the medications that they were taking, unless dependence has occurred. Patients who are abusing their medications will then actively seek out other physicians to obtain more of the same medication, often by faking or exaggerating the extent of their true condition, in order to feed their addiction to that drug. Verified reports include practices where patients self-injure or mutilate themselves, such as breaking or chipping teeth to visit emergency rooms complaining of toothaches to receive prescription painkillers.
Not all patients seeking inappropriate multiple prescriptions of drugs are doing so because of addiction or an intention to abuse the drugs for their recreational effects. Increasing scrutiny of prescribing practices and high-profile prosecutions of doctors[1] for allegedly over-prescribing drugs such as opiate painkillers and benzodiazepine tranquilizers has made many doctors extremely reluctant to prescribe large doses or repeat prescriptions of these drugs, even to patients with a legitimate medical need. Some consider the high-profile case of Richard Paey an example of such.
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[edit] Reasons for prescription-only drugs
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There are certain drugs that pharmacies cannot provide to the general public unless the client has prescription for that drug. This restriction is generally in place because at least one of the following is true:
- The drug can have severe side-effects
- The drug should not be taken over a prolonged period of time
- If combined with other drugs or alcohol, the use of the medication could have unsafe or deadly consequences
- The use of the drug needs to be supervised under a doctor's care
- The drug has a legitimate, accepted medical use, but has the potential for dependency or abuse.
[edit] Commonly abused prescription drugs
In the context of doctor shopping, the most common conditions that occur are addiction, and dependence.
Most sedatives cannot be dispensed legally without a prescription, because they have some potential for dependence. If sedatives are prescribed, they are sometimes dispensed in small quantities, which will last one week or even less. Examples of such drugs include zolpidem (Ambien), alprazolam (Xanax), and diazepam (Valium). Dependence on such medications usually arises because the patient, under their doctors recommendation, comes to rely on the effects of the drug to fall asleep, or to prevent anxiety attacks.
Prescription pain medications that contain an opiate or opioid painkiller have some potential for addiction and abuse, including oxycodone (common brand names Percocet, OxyContin), meperidine (brand name Demerol), hydromorphone (Palladone, Dilaudid), and morphine (MS Contin, Kadian, Avinza). Milder opiates and opioids (such as codeine, tramadol, and hydrocodone), are generally less addictive. Newer medications of abuse include various preparations of the extremely potent and addictive narcotic analgesic fentanyl, including Duragesic (a self-adhesive skin patch, available in four strengths) and Actiq (berry-flavored lollipops that the user sucks, available in six strengths). All of these are categorized as Schedule II drugs under the U.S. Controlled Substances Act (with the exception of tramadol and some preparations of codeine, morphine, and hydrocodone) and have stringent physical security associated with them. They must remain under lock and key at all times; every tablet must be precisely accounted for; no refills are permitted on prescriptions; and no telephone orders are accepted, with the exception of palliative care facilities (e.g., to discourage prescription fraud).
[edit] Legal issues
Because of the widespread abuse of prescription drugs in both the United States and around the world, regulatory authorities have been encouraging the practice, by cracking down on the process of doctor shopping, with some U.S. states even criminalizing the practice. Doctors have also undergone both education and training in recent years about the dangers of prescribing unneeded medication (it casts a bad light on the doctor, and often public health systems pay for prescribed medication, so it will cost the taxpayer more).
