title: Narcotic Use and Postoperative Doctor Shopping in the Orthopaedic Trauma Population.
abstract: BACKGROUND
  The negative consequences of narcotic use and diversion for nonmedical use are on the rise. A growing number of narcotic abusers obtain narcotic prescriptions from multiple providers ("doctor shopping"). This study sought to determine the effects of multiple postoperative narcotic providers on the number of narcotic prescriptions, duration of narcotics, and morphine equivalent dose per day in the orthopaedic trauma population.
  
  
  METHODS
  Our prospective cohort study used the state-controlled substance monitoring database to identify all narcotic prescriptions filled three months prior to admission and six months following discharge for enrolled patients. Patients were assigned into two groups: a single narcotic provider group with prescriptions only from the treating surgeon (or extenders) or a multiple narcotic provider group with prescriptions from both the treating surgeon and an additional provider or providers.
  
  
  RESULTS
  Complete data were available for 130 of 151 eligible patients. Preoperative narcotic use, defined by three or more narcotic prescriptions within three months of admission, was noted in 8.5% of patients. Overall, 20.8% of patients sought multiple narcotic providers postoperatively. There were significant increases in postoperative narcotic prescriptions (p < 0.001) between the single narcotic provider group (two prescriptions) and the multiple narcotic provider group (seven prescriptions), in duration of postoperative narcotic use (p < 0.001) between the single narcotic provider group (twenty-eight days) and the multiple narcotic provider group (110 days), and in morphine equivalent dose per day (p = 0.002) between the single narcotic provider group (26 mg) and the multiple narcotic provider group (43 mg). Patients with a high school education or less were 3.2 times more likely to seek multiple providers (p = 0.02), and patients with a history of preoperative narcotic use were 4.5 times more likely to seek multiple providers (p < 0.001).
  
  
  CONCLUSIONS
  There is a 20.8% prevalence of postoperative doctor shopping in the orthopaedic trauma population. Patients with multiple postoperative narcotic providers had a significant increase in postoperative narcotic prescriptions, duration of narcotics, and morphine equivalent dose per day.
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232. E-mail address for B.J. Morris: brent.joseph.morris@gmail.com.
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Morris
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232. E-mail address for B.J. Morris: brent.joseph.morris@gmail.com.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Zumsteg
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232. E-mail address for B.J. Morris: brent.joseph.morris@gmail.com.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232. E-mail address for B.J. Morris: brent.joseph.morris@gmail.com.
authors.forename: Brian
authors.initials: B
authors.lastname: Cash
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232. E-mail address for B.J. Morris: brent.joseph.morris@gmail.com.
authors.forename: Hassan R
authors.initials: HR
authors.lastname: Mir
mesh_terms: D000328:Adult; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D009141:Musculoskeletal System / Q000293:injuries* / Q000601:surgery*; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D014481:United States
chemical_list: D009294:Narcotics; D009020:Morphine