Decline in Prescription Drug Misuse More than Twice as High in States with Broad Drug Abuse Prevention Programs, New Quest Diagnostics Health Trends Study Finds
The Quest Diagnostics Health Trends™ study also found that 55% of Americans potentially put their health at risk by misusing their medications in 2013, a decrease of 8 percentage points compared to misuse rates of 63% in 2011. All age groups and both genders were at risk of misuse, based on test results.
The full study is now available at www.QuestDiagnostics.com/HealthTrends
The study's findings support previous research that suggests broad drug abuse approaches may be effective. A
"Prescription drug misuse remains at alarming levels, with more than one in two patients putting their health at risk through inappropriate and potentially dangerous misuse of drug therapies," said
"Healthcare practitioners need to know that their patients are not following their instructions," said
The majority of patients tested misused their medications
The tests report if a patient's results are consistent or inconsistent with appropriate physician-prescribed medication use. Consistent results indicate that only the drug or drugs prescribed for the patient were detected. Inconsistent results suggest a patient has misused one or more drugs. Forms of misuse include combining a prescribed drug with other non-prescribed drugs, which can lead to dangerous drug combinations; not taking a prescribed drug, which contributes to healthcare waste and failed treatment; and using other drugs, which indicates illicit drug use without a clinician's oversight.
Key findings from the study:
- All patients are at risk of prescription misuse. The high rate of prescription medication misuse (55% inconsistent) was observed across all age groups and in both genders, as well as across different types of health plans (
Medicaid, Medicareand private payer). The 8 percentage point decrease in the inconsistency rate from 2011 to 2013 suggests that physicians may be doing a better job communicating about the importance of adherence to a prescription drug regimen, that patients are exercising better prescription drug compliance, a broader representation of patients tested for drug use, or a combination of the three.
- Adolescents experienced the greatest gains in appropriate drug use. Inconsistency rates for patients ages 10-17 decreased from 70% in 2011 to 57% in 2013, an improvement of 13 percentage points. Patients ages 64 years and older had the lowest rate of inappropriate drug use, at 44%, according to test results.
- Morphine screening is an unreliable surrogate for the detection of heroin abuse in drug testing. One in 15 patients, or 6.6%, positive for the heroin metabolite 6-monoacetylmorphine tested negative for morphine. In the U.S., the number of heroin users increased nearly 80% between 2007 and 2012, according to the
Substance Abuse and Mental Health Services Administration.
"Given the growing trend of heroin abuse, clinicians should reconsider long-standing conventional wisdom that morphine testing can reliably reveal heroin abuse," said Dr. McClure.
- A small percentage of patients tamper with their test specimens to mask drug misuse from their physicians. The specimens of nearly 22,000 patients in the study, or 1.6% of those analyzed, showed evidence of specimen tampering. Patients who tested positive for misusing more than one drug were four times more likely to show evidence of specimen tampering than other patient populations.
"Prescription drug medications such as opioids and amphetamines can be enormously effective therapies, and for many people a source of better health outcomes, such as reduced pain," said
States take lead in addressing prescription drug abuse
Forty-nine states operate or have pending legislation authorizing prescription drug monitoring programs (PDMP). These programs feature electronic databases that collect prescribing and dispensing information on prescription medications of state citizens and may dispense it to individuals authorized under state law, such as physicians and law enforcement, for the purposes of their profession.
While other studies have shown PDMPs can help reduce drug abuse, the five states with the highest decline in misuse rates in the Quest Diagnostics Health Trends analysis share certain common characteristics. In addition to PDMPs, these include broadly implemented physician education programs and public awareness campaigns.
"Certain states have taken to heart the need to address prescription drug abuse, with proactive measures that involve physician and patient education as well as PDMPs and appropriate testing," said Dr. Kaufman. "The latest Quest Diagnostics Health Trends study gives early evidence that these efforts may be working."
Study Strengths and Limitations
The study's strengths are its size and national scope; use of an objective laboratory method, versus surveys or polls, which may be subject to user misrepresentation or error; confirmation of all positive drug screens by mass spectrometry, the most advanced drug testing method; and for consistency rate analysis the inclusion of patients under care by clinicians in a primary care or pain-management setting, but exclusion of those in drug rehabilitation or addiction treatment settings, where unusually high rates of drug misuse may be expected.
Study limitations include geographic disparities; inability to confirm drug misuse through access to medical records or clinical evaluation; and technical factors and patient variations, such as drug metabolism and hydration state, that may affect the reliability of a minority of results. Quest Diagnostics does not provide services to all clinicians in the U.S., so results are not broadly representative of all patients taking prescription medications in the U.S. It is also possible some clinicians tested patients due to appropriate suspicions of drug misuse, and that some clinicians omitted to specify all drugs prescribed for the patient on a test order, skewing some results.
The company's Quest Diagnostics Health Trends studies are performed in compliance with applicable privacy regulations, the company's strict privacy policies and as approved by the
About the Prescription Drug Misuse in America Report
Findings from the Prescription Drug Misuse in America report is based on an analysis of 1,409,037 de-identified urine lab test results of patients of all ages and of both genders in 46 states and the
About Quest Diagnostics Health Trends Reports
The Prescription Drug Misuse in America report is one in a series of regular Health Trends reports that examine major public health issues. Quest Diagnostics Health Trends Reports identify trends in disease and wellness based on analysis of de-identified test results from