Health & Medicine

Lexington surgeon's research on 'doctor shopping' for narcotics makes national medical journal

About 20 percent of post-operative orthopedic patients "doctor shop" for narcotics, according to research by Dr. Brent Morris, an orthopedic surgeon at the Lexington Clinic.

Morris, who conducted the research with four other doctors across the country, said the prevalence of accidental overdose was one of the reasons he wanted to explore the topic of what he terms "doctor shopping," when a patient goes to multiple doctors for pain medicine.

According to Kentucky's Office of Drug Control Policy, there were 1,004 deaths by overdose in 2012 and 1,007 overdose deaths in 2013.

Morris and his colleagues studied 130 of their patients who'd had orthopedic surgery and found 26 who doctor-shopped. The findings were published earlier this year in the Journal of Bone and Joint Surgery.

Some patterns emerged, Morris said.

About 89 percent of the patients who doctor-shopped were white, 63 percent were male, 44 percent were insured, and 85 percent had a high school education or less.

Doctor shopping was more likely to occur if a patient was taking pain medicine before surgery.

Physicians are able to track doctor shopping better than ever because 47 states now have some kind of prescription-tracking program in place, he said. In Kentucky, it's called KASPAR — the Kentucky All Schedule Prescription Electronic Reporting. The system allows doctors to see whether patients are getting prescriptions somewhere else. In Kentucky, the system also is used by law enforcement officials, dispensers and licensure boards.

"Immediate post-operative pain should be controlled by the treating surgeon," Morris said. "They should not be getting opioids from somebody else."

Morris said he hopes the data will help orthopedists identify the patients most likely to doctor-shop and offer an opportunity for doctor and patient to talk about the dangers of having too much pain medication readily available.

"We have to think about those things before we write prescriptions," he said. "It's just to sound the alarm."

"Communication is a big take-away," he said. "We need to have better awareness so we can counsel better."

It's important both for doctors to enter relevant information into KASPER and for patients to understand that doctors will strive to keep them pain-free, he said.

"That's the other side of the coin," he said. "Pain control is a very important part of care."

Some patients might seek out a second doctor because they're afraid of experiencing pain.

"We are just scratching the surface of being better at helping patients and learning from our patients to really meet their needs," he said. "One-size-fits-all doesn't apply to pain control."