Nurse Working to Stop Doctor Shopping

Saturday, November 19, 2016

Studies and counsels women who abuse prescription medication

“Doctor shopping” is a term that refers to patients with substance use disorders seeking multiple prescriptions for controlled substances from multiple prescribers — be they doctors or any other health care provider who prescribes medicine. Julie Worley, PhD, a nurse researcher and assistant professor at Rush University’s College of Nursing, is working to address this problem, which is contributing to a nationwide epidemic of prescription drug abuse.

Deaths from prescription drug overdoses have surpassed motor vehicle accidents as the leading cause of death in the United States, taking the life of one person every 20 minutes. An average of 7 million Americans misuse controlled prescription drugs each year, and approximately 500,000 people engage in doctor shopping annually.

Worley studies doctor shopping in order to develop interventions for both patients and prescribers to reduce the extent of prescription drug abuse. She also has a clinical practice at Haymarket Center, a substance abuse treatment facility in Chicago.

In addition, Worley wants to change the social stigma around the subject. She knows that “addiction,” “addict” and “drug abuse” are loaded words, and is careful to use terms such as “substance use disorder” instead. Even that language is inadequate, she feels.

“There is no term for ‘prescription drug use disorder,’” Worley says, “so I do at times use the term ‘prescription drug abuse’ because there is no alternative.”

Diverse experience

Such careful consideration and respect for her subjects and their struggles is partly a product of Worley’s impressive, diverse and extensive experience. She holds a PhD and dual certifications as a family nurse practitioner and a psychiatric mental health nurse practitioner. She’s worked in home health, public health, medical surgical nursing and pediatrics, practiced in a jail and two inpatient psychiatric units as well as in her own private practice, all of which give her a unique perspective on the behaviors of both patients and medical professionals.

Worley first encountered several doctor shoppers in her private practice. So when she was deciding on her research trajectory for her PhD, the subject was a natural fit. That research led to her co-authoring the study “Women Who Doctor Shop for Prescription Drugs,” published in 2013 in the Western Journal of Nursing Research.

Because gender differences exist everywhere, including in prescription drug abuse and doctor shopping, Worley wanted to understand women’s unique experiences. To do it, she first needed to recruit study participants, a task that proved difficult and required ingenuity.

“I put up fliers and I did all these other things,” Worley says. “But none of that worked.” So she began attending Narcotics Anonymous meetings.

“I would go to a meeting, and they’d let me introduce myself, then afterward somebody would maybe come up to me,” Worley says. “But if I didn’t go to meetings I didn’t get any participants.” It was a long but worthwhile process; she attended more than 15 NA meetings and eventually signed up 14 participants.

Bravery and compassion

“To understand and intervene in a phenomenon, it’s important to understand the experience of the people involved,” Worley says about her research. So once she found her subjects, she immersed herself in their world, which put her in difficult and sometimes dangerous situations.

At Narcotics Anonymous, she discovered that men often attended meetings to pick up women. And despite announcing herself as a researcher, she became the target of unwanted attention on several occasions.

Some attendees also used meetings to buy and sell drugs, which brought a police presence. People sometimes would be stopped coming in to a meeting.

Worley’s work outside of meetings was more dangerous but also key. She conducted interviews with participants in locations ranging from an empty office building to a halfway house.

Alone and sometimes in unsafe areas at night, she put herself at risk to gain her subjects’ trust – risks that paid off. “They even invited me to go to some of their gatherings,” she recalls. “I didn’t go, but I really became a part of their community.”

Having an impact

Going that extra mile provided an abundance of research data and helped Worley identify key themes and strategies health care professionals can use to help identify and stop doctor shopping and to provide better care for people struggling with this problem.

Since conducting her initial research, Worley has published several other articles on this topic and spoken at conferences to help people become more compassionate toward and better understand those suffering from substance abuse. For Worley’s second study, in 2015, she led a multidisciplinary team of researchers and conducted Skype interviews with psychiatric prescribers across the country.

Understanding both sides of doctor shopping enabled Worley’s team to start developing a mobile app intervention to further help health care professionals identify and prevent prescription drug abuse. Her efforts and dedication earns praise from colleagues.

“Julie cares broadly about improving treatment for individuals with substance use issues,” says Kathleen R. Delaney, PhD, professor at Rush University College of Nursing. “She is tireless in educating professionals about what they can do to improve substance use services.”

While Worley is pleased with the increased attention to prescription drug abuse, she emphasizes there’s still work to be done. “Having a substance use disorder is a chronic illness similar to diabetes or high blood pressure,” she says. “People with substance use disorders should not be treated any differently.”

For media inquiries, please contact kevin_mckeough@rush.edu.