It is essential to determine the underlying motivation of behaviour by people with multiple healthcare providers, to respond appropriately and avoid indiscriminate refusal of care for vulnerable patients. Assess whether the problem is one of substance use disorder and, if so, offer referral or treatment as the sole prescriber. Frame discussions as an expression of concern about the patient’s safety and the need to coordinate treatment with high-risk drugs. Avoid using the stigmatising term ‘doctor shopper’. Discuss the finding and confirm with the patient that the real-time monitoring is correct. If the patient denies attending a particular provider, contact that provider to establish whether or not they prescribed. Assess whether there is a reasonable explanation for obtaining drugs from other prescribers and explain that for safety reasons there is a need to know every time drugs are prescribed by other providers. Assess whether the dose is appropriate for their clinical need. Either continue treatment as the patient’s sole prescriber, or arrange referral to their preferred prescriber. Communicate this arrangement with that provider through the contact details included in the patient’s monitoring record. If there are concerns about diversion or misuse, discuss this, assess the clinical need and suggest a urine drug screen. If appropriate, offer a short-term supply, then review the results of the urine drug screen and real-time prescription monitoring at the next consultation.