Weiner evaluated doctor-shopping ED patients who had narcotic prescriptions from 10 or more providers in a year. These patients went to the doctors a lot. The average number of providers that the doctor-shoppers had seen in the previous year was 17, as opposed to 1.6 for those who aren't drug seekers, Weiner says.
In the abstract to an upcoming paper presented last weekend at the American College of Emergency Physicians Weiner acknowledges that in the ED, "recognition of patients that have aberrant drug-related behaviors is difficult" in part because physicians "do not have a high sensitivity or positive predictive value for detecting drug-seeking patients."
More than ever, physicians need to see through the differences, especially because the "Physicians might place too much weight on gestalt or stereotyping and need to rely on more objective criteria such as a patient requesting an opioid by name," Weiner wrote last July in the Annals of Emergency Medicine .
Drug-seeking behavior at the ED has been defined in various ways, he says, but includes patients who had seen at least 4 providers in 12 months before an ED evaluation. Drug overdose death rates in the U.S. have more than tripled since 1990, and "have never been higher," according to the Centers for Disease Control and Prevention. The misuse and abuse of prescription painkillers were responsible for more than 475,000 ED visits in 2009, a number that nearly doubled in five years.