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Prescription Drug Misuse Remains at Alarming Levels

Published: Thursday, April 04, 2013
Last Updated: Thursday, April 04, 2013
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Quest Diagnostics Health Trends™ analysis of a quarter million test results finds three out of five Americans tested misused their prescription medications.

Despite increased public attention on the epidemic of prescription medication abuse, about three in five Americans tested misused their prescription drugs in 2012, virtually the same as in 2011, according to a national study issued today by Quest Diagnostics.

The new study, believed to be one of the largest to examine trends in the use of commonly abused drugs such as opioid pain killers based on objective laboratory data, suggests a substantial number of patients continue to use their prescribed medications in ways that put their health at risk. The report is now available at

"Despite public education and publicity surrounding the dangers of prescription drug abuse, our study shows that misuse rates continue to be alarmingly high for opioids and other powerful medications," said F. Leland McClure, Ph.D., director, pain management, mass spectrometry operations, Quest Diagnostics. "We are hopeful that recent efforts by policy makers and public and private health professionals will help to rein in the nation's prescription drug epidemic."

The Quest Diagnostics Health Trends™ report, A Report on Marijuana and Prescription Drug Misuse in America, is based on an analysis of 227,402 de-identified urine lab-test results of patients, age 10 years and older, of both genders in 49 states and the District of Columbia performed by the company's clinical laboratories in 2011 and 2012. The testing was performed in connection with the company's prescription drug monitoring services. These services aid clinicians in monitoring patients for appropriate use of up to 26 commonly abused prescription medications, such as opioids and sedatives, and illicit drugs, such as marijuana and cocaine.

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.

The study's key findings:

•    Drug misuse continues to be highly prevalent, with three in five patients tested still misusing drugs. Sixty percent of patients tested in 2012 misused their medications, a slight improvement over the 63% inconsistency rate of 2011.
•    Marijuana was the most commonly abused drug, followed closely by opioids. Among patients with inconsistent test results in 2012, evidence of marijuana was found in more than one in four (26%) patient test results, followed by opiates (22%), benzodiazepines (16%), oxycodone (14%), cocaine (8%) and methadone (6%).
•    Drug combinations are a common form of misuse. Of patients with an inconsistent test result in 2012, about one in three, or 33%, tested positive for the prescribed drug and at least one additional drug.
•    Substantial numbers of patients did not take their medications. Among patients with inconsistent results, about 42% did not use their prescribed medication, possibly due to forgetfulness, financial constraints or illegal sales.

The study also found that men and women misused prescription drugs equally. Although misuse rates were above 50% for all government and private health plan categories, Medicaid beneficiaries had the highest rates of misuse, at 70%.

"While we had hoped for a noteworthy decline in misuse rates in 2012 compared to 2011, this was not the case," said Harvey W. Kaufman, M.D., senior medical director, Quest Diagnostics. "Not only is prescription drug misuse potentially dangerous for patients, it also contributes to healthcare waste and illegal activity. Our data underscores our nation's need for better solutions for promoting responsible use of prescription drugs."

The U.S. Centers for Disease Control and Prevention attributes 22,134 deaths in 2010 to prescription drug overdoses, a four-fold increase from 1999.

Quest Diagnostics is a leader in prescription and workplace drug monitoring by diagnostic testing. The company's Drug Testing Index™ is widely considered a benchmark in national trends of drug use by American workers. The company extended its drug monitoring services with the addition of a new portfolio of prescription drug monitoring services for clinicians in 2010.

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 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 technological 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 Western Institutional Review Board.

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