title: An analysis of the number of multiple prescribers for opioids utilizing data from the California Prescription Monitoring Program.
abstract: BACKGROUND
  Prescription monitoring programs scrutinize the prescribing of controlled substances to diminish the utilization of multiple prescribers (aka. "doctor shopping"). The use of multiple prescribers is not a problem per se and can be legitimate, as when the patient's regular physician is not available or a concurrent painful condition is being cared for by a different practitioner.
  
  
  OBJECTIVE
  The primary objective of this study was to determine if those patients who used a few prescribers (two to five) in a 1-year period were distinguishable from those who used only one prescriber.
  
  
  METHODS
  We performed a secondary data analysis of the California Prescription Monitoring Program, the Controlled Substance Utilization Review and Evaluation System, by using data collected during 1999-2007.
  
  
  RESULTS
  The group who used a few providers (two to five) differed substantially from those who visited one provider over a 1-year period. However, the dissimilarity did not suggest that these patients were more prone to the abuse of opioids.
  
  
  CONCLUSIONS
  The decision not to investigate patients who visit a low number of multiple prescribers (two to five) appears to be justifiable. If the number of providers in a given period of time is used to determine if a patient should be challenged as being a "doctor shopper," cutoffs with high specificity (low false-positive rates) should be chosen. Further epidemiologic research is needed to determine the association of the number of prescribers and misuse and/or abuse of opioids.
authors: VA Northern California Health Care System, Sacramento, CA, USA. blwilsey@ucdavis.edu
authors: Barth L
authors: BL
authors: Wilsey
authors: Scott M
authors: SM
authors: Fishman
authors: Aaron M
authors: AM
authors: Gilson
authors: Carlos
authors: C
authors: Casamalhuapa
authors: Hassan
authors: H
authors: Baxi
authors: Tzu-Chun
authors: TC
authors: Lin
authors: Chin-Shang
authors: CS
authors: Li
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D002140:California; D003625:Data Collection; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010820:Physicians / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid