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

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

Linkage of Medicare and Pharmaceutical Benefits Scheme and Coroner's Court records from Victoria.

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

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.

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.

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.