Double doctoring, also known as “doctor shopping,” is the deliberate use of more than one physician in order to obtain prescriptions for a greater amount of medications than would be prescribed by a single physician.
Doctor shopping can also refer to the act of seeking a doctor who is known for being generous with medication types and doses. This technique has become more popular with the rise of electronic patient tracking, which helps prevent double prescriptions for the same drug but may allow prescriptions for multiple similar drugs.
Research suggests that doctor shopping might be fairly common. In one study looking at pediatric appointments for acute illness, the prevalence of doctor shopping ranged from 18% of 53% of cases. However, double doctoring to obtain addictive drugs was low, accounting for 0.02% to 0.3% of the pediatric population.
This article discusses how double doctoring occurs and why it happens. It also explores the risks of doctor shopping and steps people can take if they believe someone they love is engaging in this behavior.
How Double Doctoring Happens
Usually, a doctor prescribes a drug in the amount and dosage that is necessary for the legitimate treatment of a patient’s current medical condition.
Double doctoring happens when a patient seeks out additional doctors to obtain more of the same medication, or to get a different medication which has the same effect as the one they were prescribed originally.
This can happen in a few different ways:
- Misleading or lying to the additional doctors
- Not disclosing to the additional doctor or doctors that they already have the medication from the original doctor
- Getting a secondary prescription from a telehealth provider in addition to a primary care provider
- Obtaining a stronger drug, in larger dosages and quantities, by faking or exaggerating symptoms
Regardless of how it happens, double doctoring makes it difficult for doctors to do their jobs properly.
It can also result in doctors distrusting all patients seeking the types of medications often obtained by double doctoring, such as painkillers and tranquilizers. This can lead to some innocent patients being under-medicated for their medical conditions or feeling judged or mistreated by their physicians.
The risk of addiction and overdose has led many doctors to become increasingly cautious about prescribing these medications.
Why It Happens
There are a few different reasons why people engage in double doctoring. Sometimes people with illness anxiety disorder will engage in this behavior to treat perceived ailments.
In other instances, doctor shopping can occur when patients feel dissatisfied with their initial prescriber’s diagnosis or treatment. As a result, they may seek a second opinion from another prescriber, which can result in overlapping prescriptions.
However, in many cases, people seek prescriptions from more than one doctor to either support an addiction or to sell the medications they obtain.
Addiction
One of the primary reasons people engage in double doctoring is that they are addicted to the substances they are trying to acquire. They want to get enough medication to maintain their dependence or addiction to medications such as opioid (narcotic) pain medications.
This can happen when someone needs to take more of a drug to get the same effect, but their doctor is giving them a prescription for the medication in the dosage that was effective previously and is unwilling to increase the dosage.
It is not uncommon for people to take pain medication after an injury or medical procedure and then develop a dependence on the drug. This can occur even if they take the medication as prescribed by their doctor.
Opioids are highly addictive. In some cases, dependence can develop after just two weeks of taking an opioid medication.
When a person is dependent on the drug, they develop a tolerance (meaning they need more to obtain the same effect) and experience unpleasant withdrawal symptoms if they stop taking it. This can contribute to double doctoring.
Engaging in compulsive drug use despite experiencing negative consequences is a symptom of addiction.
Drug Trafficking
In other cases, people engage in double doctoring because they want to re-sell medications to obtain money to buy other drugs, support another behavioral addiction, or need or want money for some other purpose. This is a form of drug dealing or trafficking.
In other cases, people intend to re-use the drugs in another form, such as crushing stimulant drugs (like Adderall prescribed for ADHD) to sell as a recreational stimulant or mix with or “cut” street amphetamines. Again, this is a form of drug dealing or trafficking.
The Dangers of Doctor Shopping
Doctor shopping, double doctoring, and obtaining overlapping prescriptions present several serious risks.
Risk of Addiction
Obtaining multiple prescriptions for a substance increases the risk of serious addiction. The dose and duration of use increase the risk of developing tolerance, dependence, and addiction to many substances.
Risk for Overdose
Taking a dose of a medication higher than what a healthcare provider initially prescribed increases the risk of overdose.
Other Consequences
Due to the ongoing devastation of the opioid epidemic, with increasing rates of substance use, addiction, and overdose from prescription painkillers such as fentanyl, and illicit opioids, such as heroin, regulatory authorities have been increasingly aware of and cracking down on the practice of doctor shopping.
Some U.S. states have even criminalized the practice. So if someone is caught double doctoring or doctor shopping, they may face criminal charges.
Double doctoring can also result in poor patient satisfaction, poor patient-doctor communication, increased healthcare costs, and other negative health consequences.
Preventing Double Doctoring
Most U.S. states have created a database that doctors and pharmacists can log in to if they want to check on people who they suspect are too eager for narcotic painkillers. Called prescription drug monitoring programs (PDMPs), these systems are designed to help healthcare providers identify doctor shoppers.
Although awareness is growing among physicians, not all doctors take the time to use these drug monitoring databases. Some states now require that doctors check these databases before prescribing potentially addictive or harmful drugs.
These new systems can also help identify physicians who dole out dangerous medications too casually. Increasingly, state medical licensing boards are gaining access to the programs and investigating the heaviest prescribing doctors in their state.
In recent years, doctors have also undergone education and training about the dangers of prescribing unneeded medication.
