Opioid Doctor Shopping: A Rare Phenomenon Among Patients with Chronic Non-Cancer Pain Followed in Tertiary Care Settings

Abstract

Jean-Luc Kaboré,1,2 Manon Choinière,2,3 Lise Dassieu,2 Anaïs Lacasse,4 M Gabrielle Pagé2,3,5 1Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 2Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada; 3Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 4Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Quebec, Canada; 5Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, Quebec, CanadaCorrespondence: M Gabrielle PagéResearch Centre of the Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, CanadaTel [phone] ext. 31601Fax [phone]Email [email protected]: Opioid doctor shopping has not yet been investigated in patients followed in tertiary care settings. This study aimed at assessing the prevalence of opioid doctor shopping among patients with chronic non-cancer pain (CNCP) (ie, pain lasting ≥ 3 months) attending multidisciplinary pain clinics in Quebec, Canada.Patients and Methods: This was a retrospective cohort study of patients with CNCP enrolled in the Quebec Pain Registry (QPR) between 2008 and 2014. QPR data were linked to the Quebec health insurance databases. The index date was the date of the first visit at the pain clinic. Prevalence of doctor shopping was assessed within the 12 months following the index date. Doctor shopping was defined as at least 1 day of overlapping opioid prescriptions from ≥ 2 prescribers and filled in ≥ 3 pharmacies.Results: A total of 2191 patients with CNCP with at least one opioid dispensation within the 12 months following the index date were included. The mean age was 58.6± 14.9 years and 41.3% were men. The median pain duration was 4 years, and 13.3% of patients were diagnosed with neuropathic pain. Regarding past year comorbidities, 15.0% presented anxiety, 16.8% depression and 6.4% substance use disorder. Among the included patients, 15 (0.7%) presented at least one episode of doctor shopping. Among these doctor-shoppers, 9 (60.0%) exhibited only 1 episode.Conclusion: Opioid doctor shopping is a rare phenomenon among patients with CNCP treated in tertiary care settings. Opioids should remain a drug option for patients without substance use disorder, and who have persistent pain despite optimized nonopioid therapy.Keywords: opioids, doctor shopping, chronic non-cancer pain, Quebec Pain Registry

Keywords

• opioids
• doctor shopping
• chronic non-cancer pain
• quebec pain registry