Postoperative 'doctor shopping' linked to higher narcotic use among orthopaedic patients

"Doctor shopping," the growing practice of obtaining narcotic prescriptions from multiple providers, has led to measurable increases in drug use among postoperative orthopaedic trauma patients, according to a new study presented today at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

In "Narcotic Use and Postoperative Doctor Shopping in the Orthopaedic Trauma Population," researchers reviewed prescription records for 151 adult patients admitted to an orthopaedic unit at a level one trauma center between January and December 2011. Using the Tennessee Controlled Substance Monitoring Database (CSMD), researchers compiled data on narcotic prescriptions obtained three months before, and within six months after, each patient's orthopaedic procedure.

The study found that overall, 20 percent of patients were "doctor shopping." The group that sought multiple providers for postoperative narcotics ("doctor shoppers") used narcotics four times longer than single provider patients (112 days versus 28 days); had a median of seven narcotic prescriptions compared to two prescriptions; and had a higher morphine equivalent dose (MED) each day (43 milligrams versus 26 milligrams) than the single-provider group.

The study also found that patients were 4.5 times more likely to seek out an additional provider if they had a history of preoperative narcotic use. The study authors recommend close monitoring of narcotic prescriptions and related requests following orthopaedic surgery.