Chronic Pain and Addicts
Understanding the intersection of chronic pain management, addiction, and the complex behaviors that emerge when patients seek care from multiple providers.
Counseling Chronic Pain, Addiction, and “Doctor Shopping”
I noted several reasons why more doctors do not use non-narcotic pain medications or alternative methods when trying to manage chronic pain in individuals with addiction or a host of complicated medical and psychological issues.
Starting with a lack of education, doctors face significant hurdles when using non-narcotic or alternative methods for chronic pain in patients with addiction or complex comorbidities, primarily due to limited access to specialized services, insurance barriers, and time constraints.
The subject of alternatives to opioids for managing pain is a complex and evolving topic that continues to grow in importance. Chronic pain affects millions of individuals worldwide and creates a significant economic burden. In the past, opioids were commonly used as a first-line treatment for chronic pain. Consequently, the United States is currently in the midst of an opioid epidemic. Prescribers have a legal and ethical obligation to prescribe medication responsibly. Increased opioid use over the last two decades, as well as increased deaths from illicit opioid use, has caused healthcare professionals to reevaluate their approach to chronic pain management. Pain management aims to reduce pain intensity and improve functioning while considering efficacy, adverse effects, and patient preferences. Nonopioid alternatives include nonsteroidal anti-inflammatory drugs, antidepressants, physical therapy, and interventional procedures. Tailored, multimodal approaches are essential to avoid the risks associated with opioids, including addiction and overdose, and are guided by the biopsychosocial model and patient-centered care (Dey et al., 2024).
In my opinion, as both a nurse and a patient, doctors should approach treatment for individuals with co-occurring disorders using an integrated model in which mental health and substance use conditions are treated simultaneously by a collaborative team rather than sequentially. Effective care requires combining pharmacological interventions with evidence-based psychotherapies such as Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI), along with a supportive, long-term recovery perspective.
As a nurse, I have witnessed common treatment challenges, including diagnostic pitfalls in which one disorder may mask the symptoms of another. For example, I once cared for a 16-year-old neurodivergent patient with multiple comorbidities—the presence of two or more distinct medical conditions occurring simultaneously in the same patient, with one typically identified as the primary diagnosis. After exhaustive testing, the patient received a new diagnosis; however, the patient’s rapid, unintended weight loss, nausea, severe debilitating abdominal pain, and weakness remained untreated despite repeated requests from the parent for pain relief. The physician stated that he did not want the patient to become addicted. The child eventually stated that being dead would be better than continuing to live in such pain. The child’s mother, exhausted and heartbroken, asked the physician what he would do differently if it were his own child. The physician did not respond.
The physician’s obligation to “do no harm” is rooted in the ethical principle of nonmaleficence (derived from the Latin primum non nocere), commonly associated with the Hippocratic Oath. This principle obliges physicians to act in the patient’s best interest, prioritize safety, and avoid unnecessary harm or injustice. I continue to struggle with understanding why the physician did not attempt to relieve the child’s pain.
The term doctor shopping appeared in medical literature as early as 1931 to describe patients who visited multiple doctors, often for the same illness or in search of a specific treatment. Over time, the term became strongly associated with prescription fraud and substance misuse, particularly with the rise of narcotics regulation in the mid-20th century.
Eventually, doctor shopping was legally defined as obtaining controlled substances from multiple practitioners without disclosing this information, a practice now considered illegal in all 50 U.S. states.
In answer to the question of why clients often “doctor shop” or engage in complicated methods to obtain prescription medications, I believe there are several possible explanations.
One significant reason is chronic pain management. Frustration with inadequate pain relief from a primary provider may lead individuals to seek alternative sources of care.
Some individuals may also struggle with substance use disorders and seek additional medication beyond what is prescribed. By visiting multiple physicians, they may obtain overlapping prescriptions to sustain their addiction. In other cases, patients may feel misunderstood or dismissed by their provider and believe they require more medication than they are currently receiving, prompting them to seek second opinions or additional prescriptions.
In areas with limited healthcare access, patients may feel compelled to visit multiple providers to obtain necessary medication, particularly if wait times are extensive.
If patients perceive their doctors as dismissive or lacking empathy, they may seek providers they believe will be more understanding or more willing to prescribe medications.
In some situations, certain medications may be difficult to obtain, motivating individuals to search for providers who are willing to prescribe them.
Cultural influences may also contribute. In some communities, there may be stigma associated with mental health treatment or a strong preference for pharmacological approaches to medical problems, leading individuals to pursue prescriptions from multiple providers.
According to Sansone and Sansone (2012), doctor shopping is defined as seeing multiple treatment providers either during a single illness episode or to procure prescription medications illicitly. Patient explanations for this behavior often involve clinician-related factors such as inconvenient office hours, inaccessible locations, long wait times, personal characteristics of the provider, or insufficient communication between the patient and clinician.
In my opinion, human service providers—including social workers, counselors, case managers, and addiction specialists—play a critical role in addressing the complexities surrounding doctor shopping.
Human service providers can educate patients about the risks associated with doctor shopping, including addiction and legal consequences. Increased awareness may discourage individuals from engaging in these behaviors.
They can also connect clients to appropriate mental health and substance use disorder services, reducing the perceived need to seek medications from multiple providers.
Providers may offer case management services that coordinate communication among healthcare professionals, helping ensure continuity of care and reducing the likelihood of overlapping prescriptions.
Additionally, human service providers often conduct assessments to identify underlying mental health or substance use disorders contributing to doctor shopping behaviors. Addressing these root causes can improve treatment outcomes.
Through counseling and therapeutic interventions, providers can address the emotional and psychological factors driving a patient’s urge to doctor shop while helping clients build healthier coping strategies.
At the same time, I recognize that human service systems can unintentionally contribute to the problem by creating barriers to care. Long wait times, limited service availability, fragmented systems, or inconsistent treatment recommendations may lead patients to seek multiple providers independently.
When healthcare professionals fail to communicate effectively with one another, coordinated care breaks down. This lack of communication may allow patients to see multiple doctors without providers being aware of concurrent treatments.
Furthermore, when providers perpetuate stigma surrounding substance use disorders, patients may feel reluctant to disclose their full history. As a result, they may seek care elsewhere, increasing the likelihood of doctor shopping behaviors.
Human service providers can therefore play a pivotal role both in mitigating doctor shopping and, unintentionally, contributing to it. Effective collaboration among healthcare professionals, human service providers, and mental health specialists—along with comprehensive patient education and stronger communication systems—is essential to creating a more integrated approach to care. Addressing systemic barriers within healthcare systems is critical to reducing doctor shopping practices.
Doctor shopping has significant consequences for both patients and healthcare systems. It may indicate misuse of medications, polypharmacy, reduced continuity of care, and increased medical expenses.
References
Dey, S., Sanders, A. E., Martinez, S., et al. (2024). Alternatives to opioids for managing pain. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK574543/
Sansone, R. A., & Sansone, L. A. (2012). Doctor shopping: A phenomenon of many themes. Innovations in Clinical Neuroscience, 9(11–12), 42–46.
