Multiple prescribers in older frequent opioid users--does it mean abuse?

BACKGROUND Obtaining analgesic narcotics from multiple prescribers is sometimes called 'doctor-shopping,' implying abuse. If the use of multiple prescribers can be used as an indicator for abuse, it would be a convenient way to study abuse in large populations. OBJECTIVE To assess multiple prescribers as an indicator of abuse by relating quantity of opioids obtained by older Norwegians to number of prescribers. METHODS Data were obtained from the Norwegian Prescription database which includes all prescriptions filled in Norwegian pharmacies. The study population consisted of people aged 70-89 who filled five or more prescriptions for weak or for strong opioids in 2008. RESULTS In 2008, 4,268 persons filled five or more prescriptions for strong opioids and 19,675 for weak opioids. More than 30% had three or more prescribers. Over half of strong opioids users and 72% of weak opioid users had medication-use-periods of over 40 weeks. For strong opioids, increasing DDDs/week was found with increasing number of prescribers. When cancer/palliative care patients were excluded, the mean DDDs/week level for strong opioids was much lower, and little association with number of prescribers remained. For weak opioids, little association between mean DDDs/week and number of prescribers was found. CONCLUSIONS This study demonstrated that the increasing quantities of strong opioids with increasing number of prescribers are largely due to treatment of cancer/palliative care patients. While the use of multiple prescribers can be a red flag for problematic medication use, it cannot be considered synonymous with 'doctor-shopping' or abuse.