Doctoral Dissertations

Date of Award

5-2013

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Sandra P. Thomas

Committee Members

Mary E. Gunther, Kenneth D. Phillips, David A. Patterson

Abstract

Prescription drug abuse is a significant problem in the United States with huge societal and financial cost. The 2010 National Survey on Drug Use and Health indicated that in 2009 there were 12.4 million non-medical users of prescription opioids, indicating a 10% increase from 2002. According to the Drug Enforcement Administration (DEA), the financial cost of prescription drug diversion is approximately $72 billion per year. According to the Department of Justice, doctor shopping is the primary method of diversion of prescription drugs. Doctor shopping occurs when patients visit numerous prescribers and pharmacies to obtain prescriptions for controlled drugs for illicit use, such as opiates, stimulants and benzodiazepines for illicit use or sale. In many cases females are noted to be doctor shoppers, perhaps because they are perceived more sympathetically by prescribers. The purpose of this study was to examine the experiences of female doctor shoppers through a phenomenological study guided by the philosophy of Merleau-Ponty. Participants were recruited through a flyer placed at a location where a Narcotics Anonymous group met, as well as by personal invitation of the researcher. The sample included 14 women ranging in age from 27 to 51. Participants were asked to share their experience of doctor shopping. Data from the interviews was coded and thematically analyzed. A thematic structure of the meaning of doctor shopping was developed which encompassed four themes: (1) “feeding the addiction” (2) “networking with addicts” (3) “playing the system” and (4) ”baiting the doctors.” Recommendations for future research include instrument development to measure doctor shopping and prescribing behaviors, intervention development for the treatment and support of women who engage in doctor shopping and interventions to increase responsible prescribing. Recommendations for systematic changes include improved methods to determine patients identity and insurance status, eliminating cash payments for controlled drug prescriptions and visits, advanced use of the prescription drug monitoring system, developing advanced assessment instruments and tests, and an external auditing program to ensure responsible prescribing.

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