Main Article Content

C Ineke Neutel
Svetlana Skurtveit
Christian Berg
Solveig Sakshaug


Analgesic opioids, doctor-shopping, multiple prescribers, population-based data, elderly, cancer/palliative care



Obtaining analgesic narcotics from multiple prescribers is sometimes called ‘doctor-shopping,’ implying abuse. If the use of multiple prescribers can be used as an indicator for abuse, it would be a convenient way to study abuse in large populations.


To assess multiple prescribers as an indicator of abuse by relating quantity of opioids obtained by older Norwegians to number of prescribers.


Data were obtained from the Norwegian Prescription database which includes all prescriptions filled in Norwegian pharmacies. The study population consisted of people aged 70-89 who filled five or more prescriptions for weak or for strong opioids in 2008.


In 2008, 4,268 persons filled five or more prescriptions for strong opioids and 19,675 for weak opioids. More than 30% had three or more prescribers. Over half of strong opioids users and 72% of weak opioid users had medication-use-periods of over 40 weeks. For strong opioids, increasing DDDs/week was found with increasing number of prescribers. When cancer/palliative care patients were excluded, the mean DDDs/week level for strong opioids was much lower, and little association with number of prescribers remained. For weak opioids, little association between mean DDDs/week and number of prescribers was found.


This study demonstrated that the increasing quantities of strong opioids with increasing number of prescribers are largely due to treatment of cancer/palliative care patients. While the use of multiple prescribers can be a red flag for problematic medication use, it cannot be considered synonymous with ‘doctor-shopping’ or abuse

Abstract 173 | PDF Downloads 67


1. Rønning M, Berg C, Furu K, Litleskare I, Mahic M, Sakshaug S, et al. The Norwegian Prescription Database, 2004-2009. Nydalen, Norway: The Norwegian Institute of Public Health 2010.
2. Joranson DE, Ryan KM, Gilson AM, Dahl JL. Trends in medical use and abuse of opioid analgesics. JAMA 2000;283(13):1710-4.
3. Dhalla IA, Mamdani MM, Sivilotti ML, Kopp A, Qureshi O, Juurlink DN. Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ: Canadian Medical Association Journal/Journal de l'Association Medicale Canadienne. 2009;181(12):891-6. PMCID: 2789126.
4. AMS Panel on Persistent Pain in Older Patients. Pharmacological management of persistent pain in older persons. JAGS. 2009;57:1331-57.
5. Trevisan L. Prescription opioid abuse in the elderly an urgent concern. American Academy of Addiction Psychiatry. 2012;23rd Annual Meeting & Symposium(Abstract 25).
6. Gilson AM, Kreis PG. The burden of the nonmedical use of prescription opioid analgesics. Pain Med. 2009;10 Suppl 2:S89-100.
7. Sproule B, Brands B, Li S, Catz-Biro L. Changing patterns in opioid addiction: characterizing users of oxycodone and other opioids. Canadian Family Physician/ Medecin de Famille Canadien. 2009;55(1):68-9, 9 e1-5. PMCID: 2628831.
8. Martyres RF, Clode D, Burns JM. Seeking drugs or seeking help? Escalating "doctor shopping" by young heroin users before fatal overdose. Med J Aust. 2004; 180(5):211-4.
9. Pradel V, Frauger E, Thirion X, Ronfle E, Lapierre V, Masut A, et al. Impact of a prescription monitoring program on doctorshopping for high dosage buprenorphine.
Pharmacoepidemiol Drug Saf. 2009;18(1):36-43.
10. Winther R, Bramness JG. [Prescription shopping of addictive drugs in Norway]. Tidsskr Nor Legeforen. 2009;129:517-20.
11. Katz N, Panas L, Kim M, Audet AD, Bilansky A, Eadie J, et al. Usefulness of prescription monitoring programs for surveillance - analysis of Schedule II opioid prescription data in Massachusetts, 1996-2006. Pharmacoepidemiol Drug Saf. 2010;19(2):115-23.
12. Pauly V, Frauger E, Pradel V, Rouby F, Berbis J, Natali F, et al. Which indicators can public health authorities use to monitor prescription drug abuse and evaluate the impact of regulatory measures? Controlling High Dosage Buprenorphine abuse. Drug Alcohol Depend. 2011;113(1):29-36.
13. Wilsey BL, Fishman SM, Gilson AM, Casamalhuapa C, Baxi H, Lin TC, et al. An analysis of the number of multiple prescribers for opioids utilizing data from the California Prescription Monitoring Program. Pharmacoepidemiol Drug Saf. 2011;20(12):1262-8. PMCID: 3151348.
14. Simoni-Wastila L, Tompkins C. Balancing diversion control and medical necessity: the case of prescription drugs with abuse potential. Subst Use Misuse. 2001; 36(9-10):1275-96.
15. WHO. Collaborating Centre for Drugs Statistics Methodology: ATC/DDD Index Oslo, Norway, available from: (last accessed 10/05/2013); 2011 Contract No.: Document Number|.
16. Furu K. Drug utilisation in a public health perspective: Establishing a national prescription register in Norway. Norwegian Journal of Epidemiology. 2001;11:55-60.
17. Furu K, Wettermark B, Andersen M, Martikainen JE, Almarsdottir AB, Sorensen HT. The Nordic countries as a cohort for pharmacoepidemiological research. Basic Clin Pharmacol Toxicol. 2010;106(2):86-94.
18. Moore RA, McQuay HJ. Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of randomised trials of oral opioids. Arthritis Res Ther. 2005;7(5):R1046-51. PMCID: 1257433