title: Profiling multiple provider prescribing of opioids, benzodiazepines, stimulants, and anorectics.
abstract: BACKGROUND
  The main objective of this study was to determine the prevalence of multiple providers for different controlled substances using the largest electronic prescription monitoring program (PMP) in the United States. A secondary objective was to explore patient and medication variables associated with prescriptions involving multiple providers. PMPs monitor the final allocation of controlled substances from pharmacist to patient. The primary purpose of this scrutiny is to diminish the utilization of multiple providers for controlled substances.
  
  
  METHODS
  This is a secondary data analysis of the California PMP, the Controlled Substance Utilization Review and Evaluation System (CURES). The prevalence of multiple provider episodes was determined using data collected during 2007. A series of binomial logistic regressions was used to predict the odds ratio (OR) of multiple prescriber episodes for each generic type of controlled substance (i.e., opioid, benzodiazepine, stimulant, or diet pill (anorectic) using demographic and prescription variables.
  
  
  RESULTS
  Opioid prescriptions (12.8%) were most frequently involved in multiple provider episodes followed by benzodiazepines (4.2%), stimulants (1.4%), and anorectics (0.9%), respectively. The greatest associations with multiple provider episodes were simultaneously receiving prescriptions for different controlled substances.
  
  
  CONCLUSIONS
  Opioids were involved in multiple provider prescribing more frequently than other controlled substances. The likelihood of using multiple providers to obtain one class of medications was substantially elevated as patients received additional categories of controlled substances from the same provider or from multiple practitioners. Polypharmacy represents a signal that requires additional vigilance to detect the potential presence of doctor shopping.
authors.affiliation: VA Northern California Health Care System, Sacramento, CA 95655, USA. blwilsey@ucdavis.edu
authors.forename: B L
authors.initials: BL
authors.lastname: Wilsey
authors.forename: S M
authors.initials: SM
authors.lastname: Fishman
authors.forename: A M
authors.initials: AM
authors.lastname: Gilson
authors.forename: C
authors.initials: C
authors.lastname: Casamalhuapa
authors.forename: H
authors.initials: H
authors.lastname: Baxi
authors.forename: H
authors.initials: H
authors.lastname: Zhang
authors.forename: C S
authors.initials: CS
authors.lastname: Li
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D001067:Appetite Depressants / Q000378:metabolism / Q000627:therapeutic use; D001569:Benzodiazepines / Q000378:metabolism / Q000627:therapeutic use; D002491:Central Nervous System Agents; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D010817:Physician-Patient Relations; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'
chemical_list: D000701:Analgesics, Opioid; D001067:Appetite Depressants; D002491:Central Nervous System Agents; D001569:Benzodiazepines