Doctor shopping
Encyclopedia
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 drug
s or other medical treatment. Usually a patient will be treated by their regular physician
and be prescribed a drug that is necessary for the legitimate treatment of their current medical condition. Some patients 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.
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. In the United States, increasing scrutiny of prescribing practices and high-profile prosecutions of doctors 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.
(Ambien), alprazolam
(Xanax), and diazepam
(Valium). Dependence on such medications usually arises because the patient 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 a high potential for addiction and abuse, including oxycodone
(common brand names Percocet
, OxyContin), hydrocodone
(Vicodin
, Lortab), meperidine
(brand name Demerol), hydromorphone
(Palladone, Dilaudid), oxymorphone
(Opana, Numorphan), and morphine
(MS Contin
, Kadian, Avinza). Less powerful opiates and opioids (such as codeine
, propoxyphene), and tramadol
are generally less addictive. Tramadol
is a novel, non-scheduled
analgesic similar in effect to other narcotic painkillers, but has a high risk of inducing seizures.
Newer medications of abuse include various preparations of the extremely potent and potentially addictive narcotic analgesic fentanyl, including Duragesic
(a self-adhesive skin patch, available in four strengths) and Actiq
(berry-flavored lollipops that dissolve slowly in the mouth for absorption across the buccal mucosa, 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 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 (i.e., to discourage prescription fraud).
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
's addiction to, or reliance on, certain prescription drug
Prescription drug
A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...
s or other medical treatment. Usually a patient will be treated by their regular physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
and be prescribed a drug that is necessary for the legitimate treatment of their current medical condition. Some patients 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.
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. In the United States, increasing scrutiny of prescribing practices and high-profile prosecutions of doctors for allegedly over-prescribing drugs such as opiate
Opiate
In medicine, the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant.-Overview:Opiates are so named because they are constituents or derivatives of constituents found in opium, which is processed from the latex sap of the opium poppy,...
painkillers and benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
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.
Commonly abused prescription drugs
In the United States, most sedatives can only be legally dispensed with a prescription, because they have some potential for addiction and dependence. If sedatives are prescribed, it is sometimes in small quantities, which will last one week or even less. Examples of such drugs include zolpidemZolpidem
Zolpidem is a prescription medication used for the short-term treatment of insomnia, as well as some brain disorders. It is a short-acting nonbenzodiazepine hypnotic of the imidazopyridine class that potentiates gamma-aminobutyric acid , an inhibitory neurotransmitter, by binding to GABAA...
(Ambien), alprazolam
Alprazolam
Alprazolam is a short-acting anxiolytic of the benzodiazepine class of psychoactive drugs. Alprazolam, like other benzodiazepines, binds to specific sites on the GABAA gamma-amino-butyric acid receptor...
(Xanax), and diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
(Valium). Dependence on such medications usually arises because the patient comes to rely on the effects of the drug to fall asleep, or to prevent anxiety attacks.
Prescription pain medications that contain an opiate
Opiate
In medicine, the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant.-Overview:Opiates are so named because they are constituents or derivatives of constituents found in opium, which is processed from the latex sap of the opium poppy,...
or opioid
Opioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...
painkiller have a high potential for addiction and abuse, including oxycodone
Oxycodone
Oxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine , and codeine.Oxycodone oral medications are generally...
(common brand names Percocet
Percocet
The combination oxycodone/paracetamol is a narcotic pain reliever used to treat moderate to severe acute pain, marketed by Endo Pharmaceuticals.-History:The U.S...
, OxyContin), hydrocodone
Hydrocodone
Hydrocodone or dihydrocodeinone is a semi-synthetic opioid derived from either of two naturally occurring opiates: codeine and thebaine. It is an orally active narcotic analgesic and antitussive...
(Vicodin
Vicodin
Hydrocodone/paracetamol is a combination of two analgesic products hydrocodone and paracetamol used to relieve moderate to severe pain...
, Lortab), meperidine
Pethidine
Pethidine or meperidine Pethidine (INN) or meperidine (USAN) Pethidine (INN) or meperidine (USAN) (commonly referred to as Demerol but also referred to as: isonipecaine; lidol; pethanol; piridosal; Algil; Alodan; Centralgin; Dispadol; Dolantin; Mialgin (in Indonesia); Petidin Dolargan (in Poland);...
(brand name Demerol), hydromorphone
Hydromorphone
Hydromorphone, a more common synonym for dihydromorphinone, commonly a hydrochloride is a very potent centrally-acting analgesic drug of the opioid class. It is a derivative of morphine, to be specific, a hydrogenated ketone thereof and, therefore, a semi-synthetic drug...
(Palladone, Dilaudid), oxymorphone
Oxymorphone
Oxymorphone or 14-Hydroxydihydromorphinone is a powerful semi-synthetic opioid analgesic first developed in Germany circa 1914, patented in the USA by Endo Pharmaceuticals in 1955 and introduced to the United States market in January 1959 and other countries around the same time...
(Opana, Numorphan), and morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
(MS Contin
MS Contin
MS Contin is a brand of a time-released formulation of morphine sulfate, usually taken every twelve hours for chronic pain. MS Contin is a trademark of Purdue Pharma....
, Kadian, Avinza). Less powerful opiates and opioids (such as codeine
Codeine
Codeine or 3-methylmorphine is an opiate used for its analgesic, antitussive, and antidiarrheal properties...
, propoxyphene), and tramadol
Tramadol
Tramadol hydrochloride is a centrally acting synthetic opioid analgesic used in treating moderate pain. The drug has a wide range of applications, including treatment for restless legs syndrome and fibromyalgia...
are generally less addictive. Tramadol
Tramadol
Tramadol hydrochloride is a centrally acting synthetic opioid analgesic used in treating moderate pain. The drug has a wide range of applications, including treatment for restless legs syndrome and fibromyalgia...
is a novel, non-scheduled
Controlled Substances Act
The Controlled Substances Act was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970. The CSA is the federal U.S. drug policy under which the manufacture, importation, possession, use and distribution of certain...
analgesic similar in effect to other narcotic painkillers, but has a high risk of inducing seizures.
Newer medications of abuse include various preparations of the extremely potent and potentially addictive narcotic analgesic fentanyl, including Duragesic
Duragesic
Duragesic and Durogesic are trade names of fentanyl transdermal therapeutic systems, and are used for relief of moderate to severe pain. Since Duragesic/Durogesic release Fentanyl, a potent opioid, slowly through the skin, one patch may provide 72 hours of pain relief...
(a self-adhesive skin patch, available in four strengths) and Actiq
Actiq
Actiq by Cephalon, is a solid formulation of fentanyl citrate on a plastic stick that dissolves slowly in the mouth for absorption across the buccal mucosa. Generically Actiq is a form of oral transmucosal fentanyl citrate . In the UK, Fentanyl is a Class A drug under the Misuse of Drugs Act 1971....
(berry-flavored lollipops that dissolve slowly in the mouth for absorption across the buccal mucosa, available in six strengths). All of these are categorized as Schedule II drugs under the U.S. Controlled Substances Act
Controlled Substances Act
The Controlled Substances Act was enacted into law by the Congress of the United States as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970. The CSA is the federal U.S. drug policy under which the manufacture, importation, possession, use and distribution of certain...
(with the exception of tramadol and some preparations of codeine 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
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...
facilities (i.e., to discourage prescription fraud).