Halting a Crisis: When Patients Go “Doctor Shopping”

This article is the second in a series about the epidemic of addiction to prescription pain medications, and how NEOMED is training future physicians and pharmacists to help.

When the elderly woman with arthritis in her knees and ankles refused to give a urine sample at her pain management appointment, Katherine Williams saw a red flag go up. From her NEOMED training, Williams, now a fourth-year College of Medicine student, knew to ask herself: Is this patient abusing pain medication?

The woman was enrolled in a pain management program at Summa Family Medicine Center in Akron. Williams, who was volunteering at the Center, remembers the scenario: The woman had refused to give a sample before, but had received a one-time refill of her medication. Her daughter was with her now, and she was angry that her mother was being asked for a sample.

“We kindly explained our rules and told her that if she did not abide by the rules, she would not be receiving her medication. The woman continued to talk about all of the pains that she had. I felt bad for her, as most of her complaints seemed real enough; however, I knew that certain rules had to be met,’’ says Williams.

Primary care doctors won’t just give patients chronic pain medication without sending them to pain management programs, notes Williams. And the rules at the programs are meant to hold patients accountable: Each patient signs an agreement to abide by the rules of the clinic or be dismissed from the program.

A key rule is that patients must pass an Ohio Automated Rx Reporting System (OARRS)screening, designed to prevent misuse and abuse of prescription drugs. Patients must provide a urine sample at their pain management visits every three months. And they agree to try alternative therapies, rather than to simply continue increasing the dosages of their medication as they become used to it.

That final stipulation is important, since patients who have become habituated to their medicine often go ‘’doctor shopping,’’ requesting prescriptions for pain medication –particularly opioids—from multiple physicians. Here’s where the OARRS database comes in.

OARRs collects information on all outpatient controlled substances dispensed by Ohio pharmacies—including prescriptions for chronic pain and psychiatric medications. An OARRS report contains the provider and date they wrote the prescription; the prescription strength, amount and how often it is to be taken; and the location at which it was filled.

“In our training, we were taught what to look for and what things act as red flags, such as filling multiple prescriptions,” says Williams. “If there are multiple providers listed where a patient obtained medication, the patient could be ‘doctor shopping.’”

OARRS isn’t new. It’s also a resource to help prevent potentially harmful drug interactions. But in the middle of an opioid epidemic, it’s an increasingly important tool to help pharmacists and physicians identify potential opioid abuse, says Williams.

Now working in outpatient care at Summa Health in Barberton for a fourth-year rotation, Williams routinely checks OARRS, for example, to see if a patient is asking to refill prescriptions before their standard 30-day prescription would normally be depleted.

She says, “The subject is very tricky. We would like to believe that many folks would not exaggerate their pains to get pain medication, but I am sure it happens.’’