title: Characteristics of emergency department "doctor shoppers".
abstract: BACKGROUND
  There is a need to accurately identify patients at risk for drug abuse before giving a prescription for a scheduled medication.
  
  
  OBJECTIVE
  Our aim was to describe a subset of emergency department (ED) patients that had eight or more schedule II-V prescriptions filled from eight or more providers in 1 year, known as "doctor-shopping" (DS) behavior, to compare demographic features of DS and non-DS patients, and to determine clinical factors associated with DS.
  
  
  METHODS
  We conducted a prospective, observational study of emergency providers' (EPs) assessment of patients with back pain, dental pain, or headache. EPs recorded patient demographics, clinical characteristics, and numbers of schedule II-V prescriptions, subset opioid prescriptions, providers, and pharmacies utilized in a 12-month period, as reported on the state prescription drug-monitoring program. χ(2) and t-tests were used to compare DS with non-DS patients on demographics; a multivariate logistic regression was performed to determine clinical factors associated with DS.
  
  
  RESULTS
  Five hundred and forty-four patient visits were recorded; 12.3% (n = 67) had DS behavior. DS and non-DS patients were similar in sex but differed in age, race, chief complaint, and weekday vs. weekend arrival. DS patients utilized a median of 12.0 (interquartile range [IQR] 9.0-18.0) providers compared with a median of 1.0 (IQR 0-2.0) providers in the non-DS group. Reporting allergies to non-narcotic medications (odds ratio [OR] = 3.1; 95% confidence interval [CI] 1.4-6.9; p = 0.01), requesting medications by name (OR = 2.7; 95% CI 1.5-4.9; p < 0.01), and hospital site (OR = 2.0; 95% CI 1.1-3.6; p = 0.03) were significantly associated with DS.
  
  
  CONCLUSIONS
  There are multiple clinical characteristics associated with DS in this patient population.
authors: Department of Emergency Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
authors: Scott G
authors: SG
authors: Weiner
authors: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina.
authors: Christopher A
authors: CA
authors: Griggs
authors: Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts.
authors: Breanne K
authors: BK
authors: Langlois
authors: Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts.
authors: Patricia M
authors: PM
authors: Mitchell
authors: Boston University School of Public Health, Boston, Massachusetts.
authors: Kerrie P
authors: KP
authors: Nelson
authors: Department of Emergency Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
authors: Franklin D
authors: FD
authors: Friedman
authors: Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts.
authors: James A
authors: JA
authors: Feldman
mesh_terms: D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001900:Boston; D058999:Drug-Seeking Behavior; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000517:prevention & control*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: doctor shoppers; drug seekers; opioid abuse; opioid prescribing; prescription medication abuse