This paper examines network prominence in a co-prescription network as an indicator of opioid doctor shopping (i.e., fraudulent solicitation of opioids from multiple prescribers). Using longitudinal data from a large commercially insured population, we construct a network where a tie between patients is weighted by the number of shared opioid prescribers. Given prior research suggesting that doctor shopping may be a social process, we hypothesize that active doctor shoppers will occupy central structural positions in this network. We show that network prominence, operationalized using PageRank, is associated with more opioid prescriptions, higher predicted risk for dangerous morphine dosage, opioid overdose, and opioid use disorder, controlling for number of prescribers and other variables. Moreover, as a patient's prominence increases over time, so does their risk for these outcomes, compared to their own average level of risk. Results highlight the importance of co-prescription networks in characterizing high-risk social dynamics.

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Published in PLOS ONE, v. 14, no. 10, 0223849, p. 1-16.

© 2019 Perry et al.

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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This research was funded by a grant from the National Institute on Drug Abuse (R01 DA039928) to the first author, BLP. Information about NIDA can be found at https://www.drugabuse.gov/. Funding was also provided by an Indiana University Addictions Grand Challenge Grant, and a University of Kentucky Interdisciplinary Research Collaborations Seed Grant.

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All relevant data are available on Dryad at https://doi.org/10.5061/dryad.4xgxd2552.