Deception for Drugs: 'Doctor Shopping' Among Young Adults
Deception for Drugs: 'Doctor Shopping' Among Young Adults
The percentage of each demographic group that has attempted to deceive a physician to obtain a prescription is displayed in Table 1. A χ test indicated that a significantly larger portion of men (4.8%) than women (3.1%) reported deception. The difference also was seen for both motives, although it is proportionally larger for selling (2.7% of men, 1.4% of women). Whites and blacks reported similar rates for each outcome, but a significantly larger portion of those in the "other" race category reported deception (7.8%). Additional analyses indicated that deception in this group was most frequently reported by those identifying as Hispanic or Native American (approximately 1 in 7 have attempted deception) and was reported by no Asian or Indian respondents. There seems to be no relationship between age and attempted deception within the age range of this sample. Urban residence and marital status were similarly unrelated to the outcomes (data not shown).
A significantly larger portion of student athletes reported deception. Twice the percentage of athletes reported attempted deception for the purpose of abuse (7.2% vs 3.3% of nonathletes) and 4 times the percentage reported attempted deception to obtain pharmaceuticals to sell (5.6% vs 1.8% of nonathletes). Greek affiliation (sorority/fraternity) was associated with deception for the purpose of selling (3.5% vs 1.8%) but not for personal abuse. Deception also seems to be strongly associated with sexual orientation. Of those who self-identify as lesbians, gay, bisexual, or transgender (LGBT), 14.1% reported attempted physician deception. All reported attempting deception for abuse, and 10.9% of LGBT respondents reported attempting deception to obtain pharmaceuticals to sell. Because of the small number of LGBT respondents, a cell within the contingency table used to calculate χ values would have <5 expected cases. Therefore, for this row of Table 1 only, Fisher exact test was used to assess significance.
Employment status was associated with each outcome. In each case, a significantly larger portion of those with full-time employment reported deception. An interesting relationship between family income and deception also emerged. The income groups that reported the highest rates of attempted deception were the lowest (<$10,000 annually; 9.2%) and the highest categories (≥$175,000; 9.0%); the lowest rates of deception were reported by the 4 middle groups (from $50,000 to $149,999). This pattern held true for both individual motives, although the high-income group's higher rate of attempted deception for financial purposes was not as pronounced as it was for the abuse motive.
Attempted physician deception was reported very rarely by nonusers of alcohol (1.0%) and marijuana (0.8%) compared with alcohol and marijuana users (4.4% and 6.2%, respectively). However, use of alcohol was associated only with deception for the purpose of abuse and not with deception for the purpose of selling. As would be expected, self-reported pharmaceutical abuse was strongly associated with physician deception. The percentage of pharmaceutical misusers who reported attempted physician deception was 8 times that of nonrecreational users for each outcome. Of pharmaceutical misusers, 9.5% reported attempted deception, 8.6% reported deception for the purpose of their own use, and 4.7% reported deception to obtain pharmaceuticals to sell. Thus, it seems that although it is somewhat rare in the general population, physician deception is practiced by approximately 1 of every 10 individuals who have recreationally used a pharmaceutical. The behavior is even more common among recent pharmaceutical misusers (11.4%).
Rare events logistic regression models are presented in Table 2. Because the low and high extreme income categories were most closely associated with attempted physician deception, both a linear and quadratic term were incorporated into the model to account for the apparent curvilinear relationship. In the first model, sexual orientation (b = 1.32; odds ratio [OR], 3.75), full-time employment (b = 1.15; OR, 3.16), other race (b = 0.79; OR, 2.19), and income (linear coefficient b = −0.56; OR, 0.57; quadratic coefficient: b = 0.06; OR, 1.06) were significantly associated with an increased likelihood of reporting attempted deception, whereas sex, age, and Greek affiliation were not. As expected, income seems to have a curvilinear relationship with the outcome. Alcohol, marijuana, and recreational pharmaceutical use are added to the second model. With the exception of "other" race, all significant variables in the first model retained significance at the 0.05 level. Alcohol (b = 0.17; OR, 1.19) and pharmaceutical misuse (b = 0.034; OR, 1.40) were also significant in this model.
The third model examines attempted deception only for the purpose of abuse. Before the inclusion of substance use, sexual orientation (b = 1.45; OR, 4.28), full-time employment (b = 1.29; OR, 3.63), other race (b = 0.90; OR, 2.47), and income (both the linear and quadratic terms) had significant associations with attempted deception. Each of these and pharmaceutical misuse (b = 0.35; OR, 1.42) had significant associations with the dependent variable after the inclusion of the 3 forms of substance use. The same variables (sexual orientation, full-time employment, other race, and income) were associated with physician deception for the purpose of selling in the fifth model. Once substance use was added, both income terms were reduced to marginal significance. Pharmaceutical misuse (b = 0.38; OR, 1.46) and athletic participation (b = 1.04; OR, 2.83) were also significant in the final model.
To better clarify the relationship between income and attempted deception to obtain pharmaceuticals, Figures 1 and 2 display the predicted probability of attempted deception at various pharmaceutical misuse and income levels, respectively. In each, all other predictor variables were held constant at their mean. The figures clearly depict 2 key findings: the predicted probability of attempted deception increases with the frequency of pharmaceutical misuse and is at its highest at the extremes of the income measure. Those with moderate family incomes have the lowest likelihood of attempted deception, whereas the poor and the affluent are most likely to report attempted deception.
(Enlarge Image)
Figure 1.
Predicted probability of physician deception across a range of pharmaceutical misuse.
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Figure 2.
Predicted probability of physician deception across a range of family incomes.
The respondents who did report deception were asked whether they had ever been successful at using deception to obtain a pharmaceutical that they did not need. Unfortunately, the option choices were worded in a way that only yielded limited information. Of the 93 attempting deception, 29 (31.2%) were always unsuccessful and 64 (68.8%) were successful "at least once." This form of measurement fails to differentiate between successful respondents who only attempted deception once, those who were virtually always successful, and those who might have only been successful in 1 of 10 attempts. Ideally, the survey would have included follow-up items related to how often they had attempted deception, the percentage of times they were successful, and how many different physicians they had attempted to deceive. As a result of these limitations and because physicians need insight into those trying to deceive them, our focus remains attempted deception rather than successful deception.
Results
The percentage of each demographic group that has attempted to deceive a physician to obtain a prescription is displayed in Table 1. A χ test indicated that a significantly larger portion of men (4.8%) than women (3.1%) reported deception. The difference also was seen for both motives, although it is proportionally larger for selling (2.7% of men, 1.4% of women). Whites and blacks reported similar rates for each outcome, but a significantly larger portion of those in the "other" race category reported deception (7.8%). Additional analyses indicated that deception in this group was most frequently reported by those identifying as Hispanic or Native American (approximately 1 in 7 have attempted deception) and was reported by no Asian or Indian respondents. There seems to be no relationship between age and attempted deception within the age range of this sample. Urban residence and marital status were similarly unrelated to the outcomes (data not shown).
A significantly larger portion of student athletes reported deception. Twice the percentage of athletes reported attempted deception for the purpose of abuse (7.2% vs 3.3% of nonathletes) and 4 times the percentage reported attempted deception to obtain pharmaceuticals to sell (5.6% vs 1.8% of nonathletes). Greek affiliation (sorority/fraternity) was associated with deception for the purpose of selling (3.5% vs 1.8%) but not for personal abuse. Deception also seems to be strongly associated with sexual orientation. Of those who self-identify as lesbians, gay, bisexual, or transgender (LGBT), 14.1% reported attempted physician deception. All reported attempting deception for abuse, and 10.9% of LGBT respondents reported attempting deception to obtain pharmaceuticals to sell. Because of the small number of LGBT respondents, a cell within the contingency table used to calculate χ values would have <5 expected cases. Therefore, for this row of Table 1 only, Fisher exact test was used to assess significance.
Employment status was associated with each outcome. In each case, a significantly larger portion of those with full-time employment reported deception. An interesting relationship between family income and deception also emerged. The income groups that reported the highest rates of attempted deception were the lowest (<$10,000 annually; 9.2%) and the highest categories (≥$175,000; 9.0%); the lowest rates of deception were reported by the 4 middle groups (from $50,000 to $149,999). This pattern held true for both individual motives, although the high-income group's higher rate of attempted deception for financial purposes was not as pronounced as it was for the abuse motive.
Attempted physician deception was reported very rarely by nonusers of alcohol (1.0%) and marijuana (0.8%) compared with alcohol and marijuana users (4.4% and 6.2%, respectively). However, use of alcohol was associated only with deception for the purpose of abuse and not with deception for the purpose of selling. As would be expected, self-reported pharmaceutical abuse was strongly associated with physician deception. The percentage of pharmaceutical misusers who reported attempted physician deception was 8 times that of nonrecreational users for each outcome. Of pharmaceutical misusers, 9.5% reported attempted deception, 8.6% reported deception for the purpose of their own use, and 4.7% reported deception to obtain pharmaceuticals to sell. Thus, it seems that although it is somewhat rare in the general population, physician deception is practiced by approximately 1 of every 10 individuals who have recreationally used a pharmaceutical. The behavior is even more common among recent pharmaceutical misusers (11.4%).
Rare events logistic regression models are presented in Table 2. Because the low and high extreme income categories were most closely associated with attempted physician deception, both a linear and quadratic term were incorporated into the model to account for the apparent curvilinear relationship. In the first model, sexual orientation (b = 1.32; odds ratio [OR], 3.75), full-time employment (b = 1.15; OR, 3.16), other race (b = 0.79; OR, 2.19), and income (linear coefficient b = −0.56; OR, 0.57; quadratic coefficient: b = 0.06; OR, 1.06) were significantly associated with an increased likelihood of reporting attempted deception, whereas sex, age, and Greek affiliation were not. As expected, income seems to have a curvilinear relationship with the outcome. Alcohol, marijuana, and recreational pharmaceutical use are added to the second model. With the exception of "other" race, all significant variables in the first model retained significance at the 0.05 level. Alcohol (b = 0.17; OR, 1.19) and pharmaceutical misuse (b = 0.034; OR, 1.40) were also significant in this model.
The third model examines attempted deception only for the purpose of abuse. Before the inclusion of substance use, sexual orientation (b = 1.45; OR, 4.28), full-time employment (b = 1.29; OR, 3.63), other race (b = 0.90; OR, 2.47), and income (both the linear and quadratic terms) had significant associations with attempted deception. Each of these and pharmaceutical misuse (b = 0.35; OR, 1.42) had significant associations with the dependent variable after the inclusion of the 3 forms of substance use. The same variables (sexual orientation, full-time employment, other race, and income) were associated with physician deception for the purpose of selling in the fifth model. Once substance use was added, both income terms were reduced to marginal significance. Pharmaceutical misuse (b = 0.38; OR, 1.46) and athletic participation (b = 1.04; OR, 2.83) were also significant in the final model.
To better clarify the relationship between income and attempted deception to obtain pharmaceuticals, Figures 1 and 2 display the predicted probability of attempted deception at various pharmaceutical misuse and income levels, respectively. In each, all other predictor variables were held constant at their mean. The figures clearly depict 2 key findings: the predicted probability of attempted deception increases with the frequency of pharmaceutical misuse and is at its highest at the extremes of the income measure. Those with moderate family incomes have the lowest likelihood of attempted deception, whereas the poor and the affluent are most likely to report attempted deception.
(Enlarge Image)
Figure 1.
Predicted probability of physician deception across a range of pharmaceutical misuse.
(Enlarge Image)
Figure 2.
Predicted probability of physician deception across a range of family incomes.
The respondents who did report deception were asked whether they had ever been successful at using deception to obtain a pharmaceutical that they did not need. Unfortunately, the option choices were worded in a way that only yielded limited information. Of the 93 attempting deception, 29 (31.2%) were always unsuccessful and 64 (68.8%) were successful "at least once." This form of measurement fails to differentiate between successful respondents who only attempted deception once, those who were virtually always successful, and those who might have only been successful in 1 of 10 attempts. Ideally, the survey would have included follow-up items related to how often they had attempted deception, the percentage of times they were successful, and how many different physicians they had attempted to deceive. As a result of these limitations and because physicians need insight into those trying to deceive them, our focus remains attempted deception rather than successful deception.
