Kaboré Jean-Luc, Choinière Manon, Dassieu Lise, Lacasse Anaïs, Pagé M Gabrielle
Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
J Pain Res. 2021 Jun 21;14:1855-1861. doi: 10.2147/JPR.S310580. eCollection 2021.
Opioid doctor shopping has not yet been investigated in patients followed in tertiary care settings. This study aimed at assessing the prevalence of opioid doctor shopping among patients with chronic non-cancer pain (CNCP) (ie, pain lasting ≥3 months) attending multidisciplinary pain clinics in Quebec, Canada.
This was a retrospective cohort study of patients with CNCP enrolled in the Quebec Pain Registry (QPR) between 2008 and 2014. QPR data were linked to the Quebec health insurance databases. The index date was the date of the first visit at the pain clinic. Prevalence of doctor shopping was assessed within the 12 months following the index date. Doctor shopping was defined as at least 1 day of overlapping opioid prescriptions from ≥2 prescribers and filled in ≥3 pharmacies.
A total of 2191 patients with CNCP with at least one opioid dispensation within the 12 months following the index date were included. The mean age was 58.6±14.9 years and 41.3% were men. The median pain duration was 4 years, and 13.3% of patients were diagnosed with neuropathic pain. Regarding past year comorbidities, 15.0% presented anxiety, 16.8% depression and 6.4% substance use disorder. Among the included patients, 15 (0.7%) presented at least one episode of doctor shopping. Among these doctor-shoppers, 9 (60.0%) exhibited only 1 episode.
Opioid doctor shopping is a rare phenomenon among patients with CNCP treated in tertiary care settings. Opioids should remain a drug option for patients without substance use disorder, and who have persistent pain despite optimized nonopioid therapy.
在三级医疗环境中接受随访的患者中，尚未对阿片类药物“医生购物”现象进行过研究。本研究旨在评估加拿大魁北克省多学科疼痛诊所中慢性非癌性疼痛（CNCP，即疼痛持续≥3个月）患者中阿片类药物“医生购物”的患病率。
这是一项对2008年至2014年纳入魁北克疼痛登记处（QPR）的CNCP患者进行的回顾性队列研究。QPR数据与魁北克医疗保险数据库相关联。索引日期为首次就诊疼痛诊所的日期。在索引日期后的12个月内评估“医生购物”的患病率。“医生购物”定义为来自≥2名开处方者的阿片类药物处方重叠至少1天，并在≥3家药店配药。
共有2191名在索引日期后的12个月内至少有一次阿片类药物配药的CNCP患者被纳入研究。平均年龄为58.6±14.9岁，41.3%为男性。疼痛持续时间的中位数为4年，13.3%的患者被诊断为神经性疼痛。关于过去一年的合并症，15.0%有焦虑症，16.8%有抑郁症，6.4%有物质使用障碍。在纳入的患者中，15名（0.7%）出现至少一次“医生购物”事件。在这些“医生购物者”中，9名（60.0%）仅出现1次事件。
在三级医疗环境中接受治疗的CNCP患者中，阿片类药物“医生购物”是一种罕见现象。对于没有物质使用障碍且尽管非阿片类治疗已优化但仍有持续性疼痛的患者，阿片类药物应仍然是一种药物选择。
