Early Detection of Prescription Drug Abuse Using Doctor Shopping Monitoring From Claims Databases: Illustration From the Experience of the French Addictovigilance Network

Abstract

Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence. Awareness of prescription drug abuse has been increasing in the last two decades, and organizations such as the International Narcotics Control Board has predicted that, worldwide, prescription drug abuse may exceed the use of illicit drugs. Assessment of prescription drug abuse tackles an issue that is hidden by nature, which therefore requires a specific monitoring. The current best practice is to use multiple detection systems to assess prescription drug abuse by various populations in a timely, sensitive, and specific manner. In the early 2000's, we designed a method to detect and quantify doctor shopping for prescription drugs from the French National Health Data System, which is one of the world's largest claims database, and a first-class data source for pharmacoepidemiological studies. Doctor shopping is a well-known behavior that involves overlapping prescriptions from multiple prescribers for the same drug, to obtain higher doses than those prescribed by each prescriber on an individual basis. In addition, doctor shopping may play an important role in supplying the black market. The paper aims to review how doctor shopping monitoring can improve the early detection of prescription drug abuse within a multidimensional monitoring. The paper provides an in-depth overview of two decades of development and validation of the method as a complementary component of the multidimensional monitoring conducted by the French Addictovigilance Network. The process accounted for the relevant determinants of prescription drug abuse, such as pharmacological data (e.g., formulations and doses), chronological and geographical data (e.g., impact of measures and comparison between regions), and epidemiological and outcome data (e.g., profiles of patients and trajectories of care) for several pharmacological classes (e.g., opioids, benzodiazepines, antidepressants, and methylphenidate).

Keywords: addictovigilance; benzodiazepines; claims database; doctor shopping; methylphenidate; opioids; prescription drug abuse; signals detection.

Figure 1

Method to detect and quantify doctor shopping for prescription drugs, accounting for overlapping prescriptions. *The quantity obtained by doctor shopping is calculated as Qd–Qd/n, where Qd is the quantity dispensed, n is the number of overlapping periods of prescriptions, and Qd/n is the quantity that would have been dispensed with only one prescriber.

Figure 2

Complementary indicators provided by the method.

Figure 3

Validation of doctor shopping as a pharmacological tool through its ability to rank prescription drugs within a pharmacological class known for abuse (e.g., benzodiazepines) and recover pharmacological determinants of abuse (e.g., formulation for methylphenidate and dose for oxycodone). SODAS: Spheroidal Oral Drug Absorption System; IR: Immediate-release; OROS: Osmotic-Controlled Release Oral Delivery System; CB: Coated beads. See Table 1 in Soeiro et al. (45) for details on formulations.

Figure 4

Multidimensional monitoring conducted by the French Addictovigilance Network to detect signals by crossing complementary data sources.