Connect
MJA
MJA

Seeking drugs or seeking help? Escalating “doctor shopping” by young heroin users before fatal overdose

Raymond F Martyres, Danielle Clode and Jane M Burns
Med J Aust 2004; 180 (5): 211-214.

Summary

Objective: To identify prescription drug-seeking behaviour patterns among young people who subsequently died of heroin-related overdose.

Design: Linkage of Medicare and Pharmaceutical Benefits Scheme and Coroner’s Court records from Victoria.

Subjects: Two hundred and two 15–24-year-olds who died of heroin-related overdose between 6 January 1994 and 6 October 1999.

Main outcome measures: Patterns of use of medical services and prescription drugs listed on the Pharmaceutical Benefits Scheme in the years before death, and use of all drugs just before death.

Results: Polydrug use was reported in 90% of toxicology reports, and prescription drugs were present in 80% of subjects. Subjects accessed medical services six times more frequently than the general population aged 14–24 years, and more than half of all prescribed drugs were those prone to misuse, such as benzodiazepines and opioid analgesics. A pattern of increasing drug-seeking behaviour in the years before death was identified, with doctor-visitation rates, number of different doctors seen and rates of prescriptions peaking in the year before death.

Conclusions: An apparent increase in “doctor shopping” in the years before heroin-related death may reflect the increasing misuse of prescription drugs, but also an increasing need for help. Identification of a pattern of escalating doctor shopping could be an opportunity for intervention, and potentially, reduction in mortality.

Please login with your free MJA account to view this article in full

  • Raymond F Martyres1
  • Danielle Clode2
  • Jane M Burns3

  • 1 Melbourne Division of General Practice, North Carlton, VIC.
  • 2 Department of Zoology, University of Melbourne, Parkville, VIC.
  • 3 beyondblue: the national depression initiative, Hawthorn West, VIC.

Correspondence: 

Acknowledgements: 

This research was conducted as part of the “Help understanding drug use” program conducted by the Melbourne Division of General Practice and funded by a grant from the Australian Divisions of General Practice. Data were obtained from the Health Insurance Commission, Australia, and the State Coroner’s Office of Victoria.

We would like to thank the Australian Divisions of General Practice for funding this research, and the Health Insurance Commission, Australia, the Victorian Institute of Forensic Medicine and the State Coroner’s Office of Victoria for providing data. The following individuals made significant contributions to the study: Dr Yvonne Bonomo, Ms Fleur Champion de Crespigny, Dr Andrew Chanen, Dr Malcolm Dobbin, Dr David Jacka, Dr John Jagoda, Mr Hal Rosemburg, Ms Lara Watson, Ms Mardie Whitla, Mr Kim Wyman and Professor Doris Young. We thank Dr Ian Gordon, Dr Mick Keogh and Dr Michael Nicholls for statistical advice.

Competing interests:

None identified.

  • 1. Steentoft A, Teige B, Holmgren P, et al. Drug addict deaths in Nordic countries: A study based on medicolegally examined cases in the five Nordic countries in 1991. Forensic Sci Int 1996; 77: 109-118.
  • 2. Oliver P, Keen J, Mathers N. Deaths from drugs of abuse in Sheffield 1997–1999: what are the implications for GPs prescribing to heroin addicts? Fam Pract 2002; 19: 93-94.
  • 3. Risser D, Uhl A, Stichenwirth M, et al. Quality of heroin and heroin-related deaths from 1987 to 1995 in Vienna, Austria. Addict 2000; 95: 375-382.
  • 4. Lewis P, Gaule D. Dealing with drug-seeking patients: the Tripler Army Medical Centre Experience. Mil Med 1999; 164: 838-840.
  • 5. Darke S, Ross J, Zador D, Sunjic S. Heroin-related deaths in New South Wales, Australia, 1992–1996. Drug Alcohol Depend 2000; 60: 141-150.
  • 6. Gerostamoulos J, Staikos V, Drummer OH. Heroin-related deaths in Victoria: a review of cases for 1997 and 1998. Drug Alcohol Depend 2001; 61: 123-127.
  • 7. Zador D, Sunjic S, Darke S. Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances. Med J Aust 1996; 164: 204-207. <eMJA full text>
  • 8. Hopfer CJ, Khuri E, Crowley TJ, Hooks S. Adolescent heroin use: a review of the descriptive and treatment literature. J Subst Abuse Treat 2002; 23: 231-237.
  • 9. Dobbin M. Prescription drug abuse. Melbourne: Department of Human Services, 1998.
  • 10. Longo LP, Parran T, Johnson B, Kinsey W. Addiction: Part II. Identification and management of the drug-seeking patient. Am Fam Physician 2000; 61: 2401-2408.
  • 11. White J, Taverner D. Drug-seeking behaviour. Aust Prescriber 1997; 20: 68-70.
  • 12. Bendtsen P, Hensig G, Ebeling C, Schedin A. What are the qualities of dilemmas experienced with prescribing opioids in general practice? Pain 1999; 82: 89-96.
  • 13. MDGP Help understanding drug use: HUDU – you can. Melbourne: Melbourne Division of General Practice, 2002.
  • 14. Health Insurance Commission. Annual Report 1999–2000. Canberra: HIC, 2000.
  • 15. Borgois P. The moral economics of homeless heroin addicts: confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments. Subst Use Abuse 2001; 33: 2323-2351.
  • 16. Warner-Smith M, Darke S, Lynskey M, Hall W. Heroin overdose: causes and consequences. Addict 2001; 96: 1113-1125.
  • 17. Chen C, Tsai S, Su L, et al. Psychiatric co-morbidity among male heroin addicts: differences between hospital and incarcerated subjects in Taiwan. Addict 1999; 94: 825-832.
  • 18. Latimer EA, Verrilli D, Welch WP. Utilization of physician services at the end of life: differences between the United States and Canada. Inquiry 1999; 36: 90-100.
  • 19. Pirkis J, Burgess P. Suicide and recency of health care contacts — a systematic review. Br J Psychiatry 1998; 173: 462-474.
  • 20. Appleby L, Amos T, Doyle U, et al. General practitioners and young suicides: a preventative role for primary care. Br J Psychiatry 1996; 168: 330-333.
  • 21. Jacka D, Clode D, Patterson S, Wyman K. Attitudes and practices of general practitioners training to work with drug-using patients. Drug Alcohol Rev 1999; 18: 287-291.
  • 22. Health Insurance Commission. Doctor shopping. Canberra: HIC, 2002.
  • 23. Pope D, Fernandes CMB, Bouthillette F, Etherington J. Frequent users of the emergency department; a program to improve care and reduce visits. Can Med Assoc J 2000; 162: 1017-1020.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.