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State proposes system to stop 'doctor shopping'

Posted by Karen Weintraub March 12, 2008 01:34 PM

By Stephen Smith, Globe Staff

State health regulators today proposed a major campaign to catch patients who visit multiple doctors and pharmacies in pursuit of powerful painkillers that can feed addictions.

The practice, known colloquially as "doctor shopping," has drawn increasing attention from substance abuse specialists and regulators who are concerned that prescription medication abuse is as serious a health threat as heroin and other street drugs.

The proposed tracking system, which needs the approval of the Public Health Council, would set off an alarm when a patient appeared to be abusing prescription medications, alerting the doctors who prescribed the drugs.

Paul Dreyer, the Department of Public Health official in charge of the initiative, said in an interview that the campaign is not designed to be punitive but, instead, "to hopefully catch patients who might be drifting into the direction of abuse before they drift too far. It gives physicians an early warning about the behavior of their patients."

For more than 15 years, the state has had a system to monitor the prescribing and dispensing of narcotics, such as OxyContin, Percocet, and derivatives of morphine. But that network was intended to nab doctors and dealers engaged in major drug dealing rings, as well as patients with significant abuse problems. The existing monitoring program estimated that the number of people caught doctor shopping soared by 170 percent from 1996 to 2007, when it reached nearly 3,000.

As part of the proposed push, anyone presenting a prescription for a narcotic would be required to show identification to the pharmacist. Additionally, the patient's name and other identifying information would be entered into the state database.

Then, a tracking system that has yet to be designed would hunt for patients who seek an excessive number of prescriptions from multiple doctors and pharmacies.

The proposal, which generally received a favorable review from members of the Public Health Council, could be approved by June and fully implemented early next year.

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19 comments so far...
  1. Big Brother. So typical, the governments wants to know everything about everyone.

    Posted by BBB March 12, 08 02:18 PM
  1. The government has an obligation to fight the pain killer epidemic! This is their only option-- you have to support.

    Posted by JPC March 12, 08 04:56 PM
  1. So now you want to criminalize the legitimate who need to use narcotics to catch the 3000 (?) who abuse? I am horrified to think that my name and identifying information would be entered into a state database. What privacy am I assured? This is a terrible and frightening idea. As it is, filling a legitimate prescription of this kind gets you looks in the pharmacy and you feel like a criminal because you permanently damaged a shoulder in a car accident.
    Let me repeat - a terrible and frightening idea. How do you guarantee a person's right to privacy?????

    Posted by Z Smith March 12, 08 05:21 PM
  1. I don't take any pain meds but I certainly wouldn't want my name in ANY database if I did.

    Posted by Duke March 12, 08 05:34 PM
  1. I think it's a great idea and long overdue. I have a brother who is an addict and when his supply of street drugs runs low, he can more or less go to any emergency room, rattle off some fake symptoms and get the powerful pain killers, or things like valium, that he wants. Privacy laws (and administrative practicality) prevent my family from being able to alert local hospitals to be on the lookout for him and not prescribe narcotics to him. I've always been surprised that there isn't already a database that red flags abusers. It's about time. Doctors should be able to know if the patient that just walked into the ER is a drug addict or not. People who receive a normal number of presciptions from a practitioner whose care they are legitimately under have no reason to worry. People who fill 5 percocet prescriptions issued by 5 different doctors in the same week are who this system is looking for. For people concerned about privacy, don't kid yourself you have almost no medical privacy anyway. Has anyone tried to by Sudafed (the real stuff, pseudoehpedrine)? I have to show an ID and get logged into a database for that thanks to the meth makers out there. How is this more of an outrage?

    The number who abuse is way way way more than 3000. A system like this would show how high that number really is and shut down one avenue of drug access.

    Posted by Jen March 12, 08 06:24 PM
  1. In the last six years, I have had to change doctors three times because my doctors left my HMO. Also, my local pharmacy stopped carrying Oxycontin, so when I was taking that medication, I had to go to a different pharmacy to fill it.

    It is unfair to be profiled and possibly denied medication for reasons beyond my control This new law doesn't seem to be able to distinguish between legitimate changing of doctors and use of more than one pharmacy, and addictive behavior initiated by the patient. This level of government knowledge of and interference in my personal medical needs is frightening. If the government is so interested in my doctors and medications, I wish they would offer national health care instead.

    Posted by Jill March 12, 08 07:12 PM
  1. As a healthcare provider who prescribes a variety of medications I feel this to be a helpful addition to the monitoring we are always under. Few patients understand that healthcare providers are under the scrutiny of the DEA. Why should we fear losing our license & professional life & means of support to our families to those who abuse drugs or obtain them in order to make a living by selling them. As healthcare professionals it is incumbent upon us to provide what is necessary to our patients for a quality life. It is also our duty to find non-addicting alternatives that are just as efficacious.

    Posted by Peggy March 14, 08 10:03 PM
  1. Less than 4% of people who are prescribed opioids are abusing them. As a prescriber, I really hate all the rhetoric about the so called "war on drugs"" This interferes with any provider's ability to care for the other 96% of patients who have various pain syndromes that sabotage quality of life and burden YOU and other taxpayers be either being or becoming permanently disabled. If you break your leg do YOU want to be profiled because you want pain management??? That is exactly what you are forcing us to do with this "war" talk. Check around, pain is a serious wordwide problem that has been woefully under treated. People die in excrutiating pain because of Bush's stupid "war" that results from provider phobia regarding adequate prescribing. This "war" forces us to make judgements about the people we treat because we fear sanctions even when we are prescribing in good faith. Why join dufus Bush in his stupid unsuccessful wars? Let's get real and get out of the dark ages.

    Posted by Cynthia March 15, 08 11:04 AM
  1. I personally am freakin' SICK AND TIRED of going to a doctor and or specialist and having to PAY for a visit where the "doctor" spends five minutes or less "diagnosing" my problem (when I explain it to them and produce Xray films). Then, explaining I have been treated with ____________ before and I need help for incredible pain. What comes next? Here is Toradol, no, Tramadol, no, Flexoril, Baclofen, wait, Naproxen! ANYTHING in the arsenol EXCEPT a strong, APPROPRIATE medication. In my case, a broken tailbone and disc degeneration.

    I'm a 277 lb male. Do you REALLY think a 500 MG Vocodan is enough twice a day for me? That is IF I get pissed and dance on the desk mad as hell that someone wants to dismiss me with a "oh, let's try this and this". Can you doctors get it through your head WE (the majority of your patients) are NOT wealthy can cannot afford the multiple visits to see you twenty-two times let alone the cost of filling every INefective script you so desperately want to pound down us... When YOU KNOW a narcotic is probably the best choice. It's all about PAIN MANAGEMENT. People DO hurt. And the whole tracking issue.... Don't get me started.

    Posted by Zach April 18, 08 07:43 PM
  1. what do they do if they catch someone doctor shopping a few times because the meds arent strong enough and they go thru the ones prescribed and that doctor wont prescribe anymore or anything stronger to someone who has ligit injuries?

    Posted by nancy May 29, 08 09:47 PM
  1. I hate this articles comments too. I am no-one's mother, except the dog I love dearly, but I know she would not want me to have to hurt. nor be able to get up and play or walk her, and the government or the doctor, is not my daddy. If I get relief from my pain with the "Scary" medication, that's great! Why should people have to suffer, when there IS something to get some relief from the pain? Why discover and research anything if the government or some other moran decides they want to save the world? Why not just cut the body part off or out, and just be totally miserable and in pain. It's hard enough to afford a decent doctor, that will try to work with you, much less actually listen and hear your problems. Please quit snooping around us and concentrate on the people shooting up schools and people in malls, molesting kids, and raping women, That should keep you real busy.

    Posted by laura June 2, 08 12:50 AM
  1. i have been on a waiting list to see a pain doc . i started to see another doc... after a year i got the call to see the doc i was on the waiting list for.....i quit seeing the one doc and am not going to fill the prescription until the next month is that doc shopping?

    Posted by patricia stewart July 6, 08 10:17 PM
  1. Can you tell me if the state of FL has this kind of tracking system?And if anyone else has gotten caught in that state?Thanks.

    Posted by mary jones July 15, 08 10:02 AM
  1. Why on earth does the government presume to know better than I what drugs more effectively relieve my pain?? By making it next to impossible to obtain the powerful narcotics needed to relieve chronic pain associated with serious illness, our government is interfering with our constitutional right to "life, liberty, and the pursuit of happiness". In my particular case, my "pursuit of happiness" includes the ability to keep my home up, to take care of my children, to perform everyday tasks which would, without these narcotics, be impossible. If our doctors are prevented from prescribing the meds we legitimate patients need, so many Americans will suffer needlessly. I don't know about everyone else, but I don't intend to be one of them. I encourage everyone out there who agrees with me to start writing our senators, governors, etc., in protest of having our right to sufficient medical treatment limited. PLEASE, Big Brother, have a heart!!

    Posted by Sharon P. August 3, 08 06:50 PM
  1. I have had five surgeries on my tailbone in 8 months. I moved after my 3rd surgery and so I had to switch surgeons, My first doctor had me on lortab 10mg 3X a day, when I had my 4th surgery it was twice as bad yet he put me on lortab 7.5mg 6X a day (by the way I couldn't walk, drive or sit for more than 10 minutes at a time, they removed 4 inches of skin which 3 months later is nowhere near better. Anyways after about 2 months I had another surgery in the same spot due to infection. The CVS pharmacy I used had a girl there who always felt the need to pry and ask me questions when I would go pick up my prescriptions, making it loud and available for everyone to hear about my personal problems, well she called my surgeon and said he was giving me too much medicine which I later found out, so when I went in for a checkup he came in to the room screaming at me about the amounts I have been taking, please note that I NEVER took more than what he gave me and never ran out early. He called me an addict and told me he was sending me to a pain management place. I have never felt so "low" in my life. I shouldn't have been talked to like that, especially since he was the one who was dispensing the medicine. Now when I went to see the pain doc, he treated me like an addict, I have to take a drug test, which is no problem, I don’t do drugs, but I feel like I shouldn’t have to. What is it exactly that I did wrong? I took the medicine as prescribed. Now after surgery he only has me on 5mg, which causes me to be in constant pain. I even told my regular surgeon that(he seems to be bipolar) cause he acted all happy to see me again last time and called the pain doc "hardcore" since that's not enough medicine to keep me comfy, however refuses to give me anything stronger. Is there anything I can do, I want to switch surgeons, I don’t want to be treated like a drug addict and I certainly don’t want them writing that I am in my files.

    Posted by Alison November 21, 08 09:13 PM
  1. In the last five years it has grown increasingly hard to get physicians to prescribe narcotics that are effective for pain management. When I complanied about my lower back hurting, the doctor told me that I was a drug seeker only looking to get pain killers and I had never received the first narcotic prescription for my problem.
    I found the best thing to do was to consult with a physician and just straight up ask if he or she prescribes narcotics for issues that need to be treated with narcotics.
    I saved myself a lot of time, wasted doctors visits, and a hell of a lot of money simply by consulting before making a decision. Going in to a doctors office, paying the basic clinic fee just to be seen, only to come out with a prescription for some Ibuprofen was a quick eye opener. If your physician will not prescribe the drugs you need then consult another physician. We all know there are different levels of pain and the physicians that prescribe narcotics know the risk of dependency. It happens to people all the time but it is a risk. In some states it is a crime to go to numerous doctors and NOT disclose if you are or have been taking narcotics prescribed by another physician in the last thirty days. While doctor shopping may be illegal, it is not illegal to change physicians or be seen by more than one physician as long as they know who else is treating you and what medications you have been prescribed. Personally I think the whole idea of anyones name going into a database that has filled narcotic prescriptions should be prohibited unless there is a consistent and obvious pattern of doctor shopping and filling narcotic prescriptions. It is certainly unfair to those who need narcotic medications. Paul Dreyer's idea to "hopefully catch patients who might be headed in the direction of abuse" is absurd. How does one decide that a patient is headed in the wrong direction or abusing narcotics?

    Posted by Chad Jones January 23, 09 12:37 AM
  1. Over several stress filled years I started having shoulder pain and back pain and then woke up one day as if I had been in a car wreck. I became more ill and started getting knots all over my body by 6 pm every night and I could not even lift my arms to put the dishes away. I had 3 sons, two with autism. The same year-my husband contracted Histoplasmosis and lost the sight in his right eye. I was having panic attacks from the pain that would travel up my spine and into my head. I went to many doctors, some a little helpful, some rude and uncaring...after the correct tests, I was found to be in a toxic state of Hashimotos. )Thyroid disease. I was left with fibromyalgia and very painful myofascial disorder. Very small doses of percocet with a half or Klonipin keep my pain from rising-which it will daily...over 4 years, I have not needed more Percocet. All the meds and muscle relaxers and SSRI's did not help. My doctor said I had to sign a form that I would not go to other places for pain killer, not drink alcohol and that at any time she would test me for street drugs and alcohol. If my life wasnt already fragie...I cried on the way home...I felt dirty and prayed to God that I was being judged unfairly at a time in my life I needed compasion and care. I do get peace from prayer, because Jesus suffered so much-and He was misjudged...I tell myself I am not an addict...but the law and doctors-whos hands are tied-are linking us with people who take drugs because of emotional and mental disorders. Write the government and your state medical board. My monthly script usually is spread out about 3 months...I do have some breakthrough pain, but if its at the end of the day, I relax, use ice or stretch or take a bit more percocet if I have to be up with a son late. If you dont speak up, your pain will not be addressed. I heard a joke...how much pain can a doctor withstand? ans. Lots....as long as its not his own...that may not be fair to all doctors...but it is kind of funny.
    God Bless-Keep Strong-speak up
    Susan

    Posted by Susan Edwards January 24, 09 08:23 PM
  1. i think it is bull crap for people to assume your a assict because you have pain. test do not lie. xrays do not lie. blood in your urine does not lie. who the hell is the goverment to assume this crap? you know there is plenty of ways to buy any and all drugs off the street.... who in the hell would pay a doctor visit charge? or be billed on there credit for a emergency room visit? leys not forget how you siy in hospital rooms for 5 to 6 hours..... get real.

    Posted by john February 12, 09 02:28 AM
  1. So now we have the tiger by the tail. Or do we? I understand pain and pain management and continue hopefully until Big Brother tries to shut us out. Also think about this. If I were to decide to abuse my medication, what would be the difference if I just go to my local liquor store where I could buy cases of booze, come home and drink it until I'm dead. Would the store that sold me the liquor get their license revolked or sued? America has been "high" long before prohibition. Maybe if you were to take the criminal element out of drugs, you might see UAD laboratories send Clydesdales to the White House with cases of Lorcet to Obama.

    Posted by Paul March 13, 09 03:38 PM
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Elizabeth Cooney is a former health reporter for the Worcester Telegram & Gazette, where she also was a business reporter and an editor. Earlier in her career, she edited medical books and journals at Little, Brown, and worked for Boston magazine.

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