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New data from Quest Diagnostics suggests while the rate of misuse of prescription drugs is high, there are strategies for physicians to use with patients.
Prescription medications are now a staple of medical care, with prescription medication coverage one of the 10 essential health benefits required under the Affordable Care Act. A recent study by Mayo Clinic found that 70 percent of Americans take at least one prescription drug; about 50 percent take two. And prescription medications are costly, adding about $325 billion to our nation's healthcare bill each year, according to the IMS Institute for Health Informatics.
So it is certainly ironic as well as alarming that a sizeable percentage of patients use prescribed drug therapies in ways that are inappropriate and sometimes downright dangerous.
Consider a recent study that found that a whopping 55 percent of patients showed evidence of inappropriate drug use in their clinical test results. The study of 1.4 million tests by Quest Diagnostics also found that misuse manifested in behaviors - such as combining drugs and skipping doses - that could have serious health consequences for the patient.
While the analysis is based on clinical testing services for commonly abused drugs like opioids and amphetamines, the Quest scientists only examined test data from patients in primary-care settings and excluded those treated by addiction centers and other practices that may have skewed the results. In other words, the study sheds insights into the use of prescription drugs by patients likely under treatment for pain and other non-drug abuse health conditions typically handled by primary-care physicians.
A deeper analysis of the Quest data indicates that issues of misuse are complex and multi-faceted. They also provide insights that primary-care and other medical practitioners will find useful as they consider drug therapies for their patients.
Signs of progress
The overall 55 percent rate of inconsistency - test results that do not reflect correct adherence to prescribed medication - reflects an eight percentage point decrease from 2011 to 2013. That means that while the rate is still unacceptably high, at least it is decreasing.
Risk for abuse
High rates of drug misuse were observed across all age groups and in both genders, as well as across all types of insured (Medicaid, Medicare, and private health plans). While seniors (65+) showed the greatest rate of medication compliance, inconsistency was still high, at 44 percent. This finding is particularly startling considering older adults account for one-third of all prescriptions written in the United States.
Adolescents and drug use
Given the epidemic of teen drug abuse - studies show that 1 in 4 teens admit to having taken a medicine that was prescribed for someone else - Quest researchers were surprised to find that adolescents experienced the greatest gains in appropriate drug use in the past three years. Among patients age 10-17 group, inconsistency rates decreased from 70 percent in 2011 to 57 percent in 2013, an improvement of 13 percentage points.
Morphine screening and heroin
One in every 15 patients who tested positive for the heroin metabolite 6-monoacetylmorphine tested negative for morphine. Clinicians should reconsider long-standing conventional wisdom that morphine testing can reliably reveal heroin abuse - particularly given new data that shows the prevalence of heroin has increased in recent years.
It should be no surprise that some patients try to mask inappropriate drug use from their physician. But it is surprising how many patients do make the attempt. Nearly 2 percent of specimens - or nearly 22,000 patients - in the Quest study showed evidence of specimen tampering.
So what do these findings mean for the practicing physician?
1.Recognize that a patient - any patient - prescribed a drug therapy is at risk for abusing or misusing that drug. Doctors often tell me that they can spot a patient who is likely to misuse their opioid or other prescription medication, but that logic flies in the face of the Quest analysis of objective test data.
2. Educatepatients that certain behaviors can impact the quality of their healthcare. One example is failing to tell their doctor about all the drugs they are taking or that they aren't following a dosing schedule in order to save money on prescriptions. A clinician who takes the time to question and counsel their patients may uncover information that could put their patient at risk.
Clinicians should reconsider the conventional wisdom that morphine testing can reliably reveal heroin abuse: it doesn't. This is crucial to remember given the increasing prevalence of heroin use in recent years.
3. Acknowledge that while patients may lie, clinical lab tests don't. Specimen validity testing can help reduce the risk that a drug abuse problem slips through the cracks undetected.
Prescription medication testing is one tool providers can utilize to monitor patient treatment plans, identify drug compliance, diversion or abuse, and help meet state and federal regulatory requirements for controlled substances.
For today's physicians, the possibility that a patient will misuse prescription drug therapies is an occupational hazard - but it doesn't have to be. If there is one takeaway from the Quest Diagnostics study, it is that too many patients don't recognize the dangers of prescription drug misuse. Physician education and vigilant oversight can go a long way toward alleviating this dangerous medical concern.
Leland McClure, PhD, MSci, F-ABFT, is director of toxicology and mass spectrometry operations at Quest Diagnostics, the world's leading provider of diagnostic health information. The 2014 Quest Diagnostics Health Trends report can be accessed at bit.ly/drug-misuse.