More Than Half of Patients Misuse Prescription Drugs, Study Finds

A majority of American adults taking opioids and other commonly prescribed medications are misusing them, including combining them with other drugs in dangerous ways, according to a new study by Quest Diagnostics.

The study, “Prescription Drug Monitoring Report 2016: Prescription Drug Misuse in America,” is thought to be the largest examination to date of prescription drug misuse patterns based on physician-ordered lab tests. “By every means of slicing the data—by age, gender, geography, and payer type—patients were at high risk for misuse,” the analysis noted.

The CDC recently issued guidelines recommending that healthcare providers perform drug tests on their patients prior to starting, and periodically during, opioid drug therapy so that they have objective information that will help them assess patients’ use of prescribed medications, other controlled substances, and illicit drugs. Such baseline tests provide evidence, based on laboratory results, of drug misuse, which is defined as use or combining of nonprescribed drugs, as well as skipping doses of prescribed drugs, in a manner that is inconsistent with ordering physicians’ directions.

Quest’s multiyear analysis (2011-2015) of more than 3 million de-identified test results from patients in 49 states and the District of Columbia showed that 54% of patients results tested in 2015 showed evidence of drug misuse, slightly higher than the 53% misuse rate in 2014. The rate of misuse was actually down 14% from the 2011 rate of 63%, however. The study excluded data from rehabilitation clinics and addiction specialists.

The analysis found that 1.6% of patients tested for heroin use showed evidence of heroin use, and heroin was detected across all age ranges in adults tested—including those above age 65. It was most likely to be detected in patients 25 to 34 years of age (3.6% among those tested) and ages 18 to 24 (3.24%). One in 3 patients (28.6%) with positive results for taking heroin were found to combine it with benzodiazepines, and in 92% of these patients, the benzodiazepines were not prescribed by a physician. Self-administration of heroin and benzodiazepines is a deadly combination of drugs that can result in respiratory depression and death, and government statistics show that from 2001 to 2014 there was a 5-fold increase in the total number of deaths related to benzodiazepines.

Intravenous use of opioids and other prescription drugs have been associated with infectious diseases including HIV and hepatitis C virus (HCV) infection. The analysis shows that HCV-positive patients were more likely to use additional, nonprescribed drugs than HCV-negative patients (66.1% versus 50.9%). The HCV-positive patients also showed evidence of using nonprescribed opiates, fentanyl, and heroin at a far higher rate than those who tested negative for HCV.

The rate of drug misuse in children showed significant improvement, dropping 44% in 2015. The improvement may reflect greater oversight by parents and guardians.

The key takeaway from this nationally representative study is that despite some gains, a large number of patients use prescription drugs inappropriately--even dangerously, according to researcher Harvey W. Kaufman, MD, senior medical director at Quest.

“The CDC’s recent recommendations to physicians to carefully weight the risks and benefits of opioid drug therapy are a step in the right direction, but clearly more needs to be done to address this public health crisis,” he said in a statement.