Doctor Shopping Laws

Description

Doctor-shopping laws target patients who obtain multiple prescriptions for controlled substances from multiple prescribers or pharmacies without disclosing their other prescriptions.

Objective(s)

To deter patients from obtaining multiple prescriptions for controlled substances for abusive or diversionary purposes

Typical Elements

Every state and the District of Columbia has a fraud law to prevent doctor-shopping, and most of them contain some version of the language from the Narcotic Drug Act of 1932 (NDA) or the Uniform Controlled Substances Act of 1970 (CSA). Additionally, 20 states have implemented more specialized doctor-shopping laws (Centers for Disease Control and Prevention [CDC], n.d.).

  • California, Colorado, Connecticut, Hawaii, Indiana, Maryland, Minnesota, Missouri, Montana, New York, Oklahoma, Vermont, Virginia, and Washington State use NDA language in their general fraud law (CDC, n.d.).
    • Note: The “Fraud or Deceit” section of the NDA states, “No person shall obtain or attempt to obtain a narcotic drug, or procure or attempt to procure the administration of a narcotic drug, (a) by fraud, deceit, misrepresentation, or subterfuge; . . . or (c) by the concealment of a material fact . . . ” (CDC, n.d., p. 2).
  • Alaska, Delaware, Illinois, Louisiana, Massachusetts, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Texas, Utah, West Virginia, Wyoming, and Washington, D.C., use CSA language in their general fraud law (CDC, n.d.).
    • Note: Relative to the NDA, the CSA “include[s] similar language; however, it [does] not include the phrase ‘concealment of material fact’” (CDC, n.d., p. 2).
  • Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Iowa, New Hampshire, New Mexico, North Carolina, Pennsylvania, Rhode Island, South Carolina, Tennessee, and Wisconsin use both NDA and CSA language in their general fraud law (CDC, n.d.).
    • Note: Although there are few substantive differences in the language used in the NDA and CSA, the Acts are not identical. States using both Acts’ language can have two separate statutes or a single statute pulling language from each Act.
  • Kansas, Kentucky, Maine, New Jersey, and Ohio use neither NDA nor CSA language in their general fraud law (CDC, n.d.).
  • Connecticut, Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Montana, North Carolina, New Hampshire, Nevada, New York, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, West Virginia, and Wyoming have specialized doctor-shopping laws with levels of detail not found in NDA or CSA—for example, laws regarding the timeframe during which patients must disclose previous and existing prescriptions to prescribers or pharmacists, and the types of prescriptions that patients must disclose (CDC, n.d.).
  • Penalties for violating doctor-shopping laws specify a range of consequences based on an individual’s history of past offenses and the scope of the violation (National Alliance for Model State Drug Laws [NAMSDL], 2010).
    • The charge for individuals who violate a doctor-shopping law can range from a Class A misdemeanor to a Class C felony, depending on the state and other factors (NAMSDL, 2010).
    • Penalties can include fines up to $5,000 or anywhere from 1 to 25 years in prison.

Populations

Prescribers, pharmacies, patients

Outcomes

When implemented in conjunction with PDMPs, doctor-shopping laws have been associated with reductions in the following:

  • Pharmacy hopping and nonmedically-necessary prescriptions of benzodiazepines in New York (Pearson et al., 2006)
  • Prescription drug diversion indicators in France, such as the number of identified instances of doctor-shopping and the percentage of certain types of prescriptions obtained through doctor-shopping (Pradel et al., 2009)
  • “Inappropriate prescriptions” for opioids and benzodiazepines in British Columbia
    • Note: This study identified “inappropriate prescriptions” as those for 30 or more doses issued and filled by a different prescriber and pharmacy within seven days of an earlier prescription for the same medication (Dormuth, Miller, Huang, Mamdani, & Juurlink, 2012).

Guidelines

Doctor Shopping Laws.

State Doctor Shopping and Prescription Fraud Statutes. 

Acknowledged by

Office of National Drug Control Policy. Epidemic: Responding to America’s Prescription Drug Crisis

References

Centers for Disease Control and Prevention. (n.d.). Doctor shopping laws. Retrieved from http://www.cdc.gov/phlp/docs/menu-shoppinglaws.pdf

Dormuth, C. R., Miller, T. A., Huang, A., Mamdani, M. M., & Juurlink, D. N. (2012). Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines. Canadian Medical Association Journal, 184(16), E852–E856. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494359/

National Alliance for Model State Drug Laws. (2010). State doctor shopping & prescription fraud statutes. Retrieved from https://namsdl.org/wp-content/uploads/State-Doctor-Shopping-and-Prescription-Fraud-Stautes.pdf

Office of National Drug Control Policy. (2011). Epidemic: Responding to America’s prescription drug abuse crisis. Retrieved from https://www.ncjrs.gov/pdffiles1/ondcp/rx_abuse_plan.pdf

Pearson, S.-A., Soumerai, S., Mah, C., Zhang, F., Simoni-Wastila, L., Salzman, C.,  . . .  Ross-Degnan, D. (2006). Racial disparities in access after regulatory surveillance of benzodiazepines. Archives of Internal Medicine, 166(5), 572–579. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/409923

Pradel, V., Frauger, E., Thirion, X., Ronfle, E., Lapierre, V., Masut, A.,  . . .  Micallef, J. (2009). Impact of a prescription monitoring program on doctor-shopping for high dosage buprenorphine. Pharmacoepidemiology and Drug Safety, 18(1), 36–43.