Doctor shopping

Doctor shopping or double doctoring refers to the practice of a patient requesting care from multiple physicians, often simultaneously, without making efforts to coordinate care or informing the physicians of the multiple caregivers. This usually stems from a patient's addiction to, or reliance on, certain prescription drugs or other medical treatment. Usually a patient will be treated by their regular physician and be prescribed a drug that is necessary for the legitimate treatment of their current medical condition. Some patients will then actively seek out other physicians to obtain more of the same medication, often by faking or exaggerating the extent of their true condition, in order to feed their addiction to that drug.

Not all patients seeking inappropriate multiple prescriptions of drugs are doing so because of addiction or an intention to abuse the drugs for their recreational effects. In the United States, increasing scrutiny of prescribing practices and high-profile prosecutions of doctors for allegedly over-prescribing drugs such as opiate painkillers and benzodiazepine tranquilizers has made many doctors extremely reluctant to prescribe large doses or repeat prescriptions of these drugs, even to patients with a legitimate medical need.

To accurately determine which patients are suffering from genuine pain and not necessarily abusing medications, a physician must distinguish between patient tolerance, dependence, and addiction. Tolerance happens when a patient is no longer responding to a drug in the way they initially did. Dependence develops when the neurons adapt to the repeated drug exposure or only function normally in the presence of the drug. Addiction is a chronic relapsing brain disease. It is characterized by compulsive drug seeking and use.

The cause of increased abuse may be connected to an emphasis in modern medicine to relieve pain. This has inadvertently led to an increased supply of these medications that is more easily available. Some view prescription drugs as a "safer" way to get high compared to street drugs. Others become dependent or addicted when the medication is inappropriately prescribed or when they have been necessary in the treatment of a long-term illness or injury. Some seek prescriptions to sell because they have a high street value.

Commonly abused prescription drugs
In the United States, most sedatives can only be legally dispensed with a prescription, because they have some potential for addiction and dependence. If sedatives are prescribed, it is sometimes in small quantities, which will last one week or even less. Examples of such drugs include zolpidem (Ambien), alprazolam (Xanax), and diazepam (Valium). Dependence on such medications usually arises because the patient comes to rely on the effects of the drug to fall asleep, or to prevent anxiety attacks.

Prescription pain medications that contain an opiate or opioid painkiller have a high potential for addiction and abuse, including oxycodone (common brand names Percocet, OxyContin), hydrocodone (Vicodin, Lortab), meperidine (brand name Demerol), hydromorphone (Palladone, Dilaudid), oxymorphone (Opana, Numorphan), and morphine (MS Contin, Kadian, Avinza). Less powerful opiates and opioids (such as codeine, propoxyphene), and tramadol are generally less addictive. Tramadol is a novel, non-scheduled analgesic similar in effect to other narcotic painkillers, but has a high risk of inducing seizures.

Newer medications of abuse include various preparations of the extremely potent and potentially addictive narcotic analgesic fentanyl, including Duragesic (a self-adhesive skin patch, available in five strengths which are 12 µg/h, 25 µg/h, 50 µg/h, 75 µg/h, and 100 µg/h each to be applied for three days) and Actiq (berry-flavored lollipops that dissolve slowly in the mouth for absorption across the buccal mucosa, available in six strengths). All of these are categorized as Schedule II drugs under the U.S. Controlled Substances Act (with the exception of tramadol and some preparations of codeine and hydrocodone) and have stringent physical security associated with them. They must remain under lock and key at all times; every tablet must be precisely accounted for; no refills are permitted on prescriptions; and no telephone orders are accepted, with the exception of palliative care facilities (for example, to discourage prescription fraud).

Legal issues
Because of the widespread abuse of prescription drugs in both the United States and around the world, regulatory authorities have been discouraging the practice by cracking down on the process of doctor shopping, with some U.S. states even criminalizing the practice. Doctors have also undergone both education and training in recent years about the dangers of prescribing unneeded medication.