Impact of a prescription monitoring program on doctor-shopping for high dosage buprenorphine.
OBJECTIVE
Doctor-shopping (simultaneous use of several physicians by a patient) is one of the most frequent ways of diversion for prescription drugs. A specific method was used to assess the evolution of doctor-shopping for High Dosage Buprenorphine (HDB) in a French region from 2000 to 2005 and the impact of a prescription monitoring program for HDB implemented in 2004.


METHODS
Data from eight periods (semesters of years 2000, 2002, 2004, and 2005) were extracted from a prescription database. Three quantities (the delivered, the prescribed, and the doctor-shopping quantity) were computed for each patient. The total doctor-shopping quantity and the doctor-shopping ratio (percentage of buprenorphine obtained through doctor-shopping) were used to evaluate the diversion of HDB among the population. The total prescribed quantity and the number of patients treated regularly were used as indicators of the access to treatment.


RESULTS
The doctor-shopping ratio increased from 1st semester 2000 to 1st semester 2004 (from 14.9 to 21.7%) and then decreased to 16.9% in 2nd semester 2005. The total doctor-shopping quantity followed the same evolution. The number of patients treated remained stable from 1st semester 2000 to 2nd semester 2005. The prescribed quantity increased from 1st semester 2000 to 2nd semester 2002, decreased in 1st semester 2004 (4163 g) and then remained stable.


CONCLUSIONS
After a four-year increase of the diversion through doctor-shopping for buprenorphine the beginning of the prescription monitoring program was concomitant with a marked decrease of doctor-shopping indicators without notable impact on the access to treatment.
Pradel
Vincent
V
Public Health Department, Center for Evaluation and Information on Pharmacodependence (CEIP), School of Medicine, Marseille, France.
Frauger
Elisabeth
E
Thirion
Xavier
X
Ronfle
Eléonore
E
Lapierre
Véronique
V
Masut
Alain
A
Coudert
Christine
C
Blin
Olivier
O
Micallef
Joëlle
J
D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects; D016208:Databases, Factual; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D009294:Narcotics / Q000008:administration & dosage* / Q000009:adverse effects; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control*
D009294:Narcotics; D002047:Buprenorphine