The issue of doctor shopping -- visiting numerous doctors to
fraudulently get prescription drugs -- has been raised in numerous
celebrity deaths, including Anna Nicole Smith, Michael Jackson and
Health Ledger. Doctors say they often rely on their own instant
judgments in the office and have little reliable means of
double-checking the patients' information.
"It puts doctors in
the uncomfortable position of playing private eye," said Dr. Lance
Longo, medical director of Addiction Psychiatry at Aurora Behavioral
Health Services in Milwaukee, Wisconsin. "We're trained to relieve pain
and suffering. Unfortunately, with the widespread misuse of controlled
substances and diversion risks, we're often taken advantage of."
Haim
obtained doses of Vicodin, Valium, Soma, Oxycontin and Xanax from seven
doctors, filled at seven pharmacies, said California Attorney General
Jerry Brown in a news conference Tuesday. Vicodin and Oxycontin are
painkillers; Valium and Xanax are anti-anxiety medications; Soma is a
muscle relaxant.
The 38-year-old actor died last month after
collapsing at a Los Angeles apartment. The cause of death is pending,
awaiting a toxicology report.
Haim had visited several emergency
rooms and urgent care clinics with complaints of an injured shoulder or
depression, according to investigators.
Doctor shoppers often
visit facilities where medical professionals don't know them, experts
say. They also call during weekends or ask for prescription refills
using excuses such as having dropped the pills in toilets or getting
pills wet on a camping trip, physicians said.
Misuse of
prescription drugs is a growing problem. Estimated hospitalizations for
poisoning by prescription opioids, sedatives and tranquilizers increased
65 percent from 1999 to 2006, according to a study in the May edition
of the American Journal of Preventive Medicine.
Report:
Hospitalizations spike for prescription drug poisonings
Doctor
shopping is a problem, but it's not the chief way prescription drugs
end up with people for whom they're not intended, said David Brushwood,
professor of pharmaceutical outcomes and policy at the University of
Florida in Gainesville.
"It's a relatively insignificant source
of diverted prescription drugs, as compared with theft from drug stores,
warehouses, acquisition over the Internet, theft from people's homes."
To curb prescription drug abuse, 34 states have prescription
monitoring programs, but their requirements and effectiveness vary,
experts said.
In those states, a record from the prescription
drug purchase is sent to the state agency that oversees the monitoring
programs. Doctors can request reports online and find out what
medications a patient has received in the past six months to a year.
This information helps doctors, said John Eadie, director of the
Prescription Drug Monitoring Program Center of Excellence at Brandeis
University.
"There are doctor shoppers, who see 15 doctors and
pharmacies or more by deceiving physicians for professed pain and other
disability that would cause prescribing these drugs," he said. "If
doctors know they are obtaining drugs from other prescribers, they might
be really reluctant to prescribe."
But these monitoring programs
have limitations, Brushwood said.
It's easy to dodge the system
by providing different names and identification numbers or buying drugs
in neighboring states, he said. Most state laws do not require the
doctors to look at the patient's drug history.
Many health
professionals don't use the monitoring system anyway, Brushwood said. In
his research, many expressed skepticism about the accuracy of the
information and complained it was "time consuming" and did not "seem
necessary," he said.
Doctors have other tools to prevent being
duped.
"We're doing addiction screening in our clinics," said Dr.
Doris K. Cope, professor and vice chairman for pain medicine in the
department of anesthesiology at the University of Pittsburgh School of
Medicine. "If someone is at high risk for addiction, we try to identify
them, and we have one of our pain psychologists evaluate them. We then
make appropriate referrals for their continued care."
They also
test urine to see whether it matches the patient's medication history.
"If someone comes in and can barely move, they put on this big
drama, then you see them get up and run out the door, even my youngest
son could figure that out," said Cope, a member of the American Society
of Anesthesiologists' Committee on Pain Medicines.
Some employ
clever strategies such as memorizing symptoms to get a certain
prescription or telling their doctors they have allergies to particular
medication to get a stronger drug. But physicians have to walk a fine
line, said Longo, a psychiatrist.
"We all have the expectation to
practice prudent, conscientious medicine, but we're not trained to be
DEA agents," Longo said. "We don't want to alienate patients who aren't
addicted or abusing drugs. The majority of patients who have legitimate
illnesses feel stigmatized getting controlled drugs."
Some of the
popularly abused drugs include oxycodone, hydrocodone, benzodiazepine
and methamphetamine.
"This is the addiction
epidemic of our time," Longo said.
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