Defining "Doctor Shopping" with Dispensing Data: A Scoping Review

Background: "Doctor shopping"typically refers to patients that seek controlled substance prescriptions from multiple providers with the presumed intent to obtain these medications for non-medical use and/or diversion. The purpose of this scoping review is to document and examine the criteria used to identify "doctor shopping"from dispensing data in the United States. Methods: A scoping review was conducted on "doctor shopping"or analogous terminology from January 1, 2000, through December 31, 2020, using the Web of Science Core Collection (seven citation indexes). Our search was limited to the United States only, English-language, peer-reviewed and US federal government studies. Studies without explicit "doctor shopping"criteria were excluded. Key components of these criteria included the number of prescribers and dispensers, dispensing period, and drug class (e.g., opioids). Results: Of 9,845 records identified, 95 articles met the inclusion criteria and our pool of studies ranged from years 2003 to 2020. The most common threshold-based or count definition was (≥4 Prescribers [P] AND ≥4 Dispensers [D]) (n = 12). Thirty-three studies used a 365-day detection window. Opioids alone were studied most commonly (n = 69), followed by benzodiazepines and stimulants (n = 5 and n = 2, respectively). Only 39 (41%) studies provided specific drug lists with active ingredients. Conclusion: Relatively simple P × D criteria for identifying "doctor shopping"are still the dominant paradigm with the need for ongoing validation. The value of P × D criteria may change through time with more diverse methods applied to dispensing data emerging.