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Patient Safety at Risk as 52% of Adults Misuse Prescriptions, Opioids

Despite marked improvements in the rates of prescription drug misuse, patient safety remains a critical issue for users of opioids and other substances.

Patient safety and substance misuse

Source: Thinkstock

By Jennifer Bresnick

- More than half of adult patients misused one or more prescription drugs in 2016, according to a new Quest Diagnostics analysis, including legal and illegal opioids. 

The high rate of substance misuse – including the 22 percent of specimens that tested positive for non-prescribed or illicit drugs in addition to valid prescriptions – raises serious patient safety questions and likely contributes to the extraordinarily high rate of overdoses that killed more than 33,000 people in 2015.

However, the report on 3.4 million de-identified patient specimen laboratory results does contain some good news.  Misuse rates have dropped by 11 percent since 2011, driven largely by a drastic improvement among teenagers.

While 70 percent of adolescents aged 10 to 17 showed signs of substance misuse in 2011, just 29 percent exhibited inappropriate drug use in 2016.

Quest attributes the improvements to improved patient education about potential negative interactions and better patient compliance with recommended drug regimens, although much work still remains to ensure optimal adherence, reduce potential patient safety concerns, and prevent individuals from misusing opioids.

Rates of prescription drug misuse from 2011 to 2016

Source: Quest Diagnostics

READ MORE: ICU Admissions from Opioid Overdoses Increase 34% Since 2009

“Laboratory test results provide objective information that can assist healthcare providers with assessing patients’ use of prescribed medications, other controlled prescription medications, and illicit drugs,” the report states.

Specimens are labeled “consistent” when the drugs found in the sample match the list of prescription medications provided by the requesting healthcare provider.  If a sample is flagged as “inconsistent,” the specimen could include additional substances or no substances at all, indicating that the patient is non-compliant with a suggested regimen.

“Combining a prescribed drug with non-prescribed or illicit drugs can lead to dangerous drug combinations, and suggests the possibility that the patient is using a drug or drugs without the benefit of oversight from a healthcare provider,” the study explains.

“Not taking a prescribed drug may contribute to healthcare waste and failed treatment, and the potential for unintentional or criminal diversion.”

Additional drugs not included in accompanying documentation accounted for 43 percent of the cases flagged as inconsistent in 2016.  In 23 percent of cases, a completely different set of drugs was found.  The remaining 34 percent of specimens contained no substances at all, even though the patients had been prescribed certain medications.

Distribution of inconsistent drug specimens

Source: Quest Diagnostics

READ MORE: CMS Releases Medicare Opioid Prescribing Maps, Data Resources

Dangerous combinations of opioids were present in a large proportion of the inconsistent samples.  Nineteen percent of specimens that tested positive for heroin also included non-prescribed fentanyl, a powerful painkiller often mixed with heroin to boost its effects. 

Even small amounts of fentanyl, which can be added to heroin without the user’s knowledge, may depress respiration and raise the possibility of an accidental overdose.

Geographically, evidence of non-prescribed fentanyl was mostly commonly found in Missouri, Ohio, Oklahoma, and Mississippi, all of which exhibited positivity rates of more than four percent.  Alabama, Florida, California, New York, Massachusetts, and Pennsylvania also exhibited high levels of fentanyl use.

Geographical distribution of fentanyl use

Source: Quest Diagnostics

Combinations of benzodiazepines, opioids, and alcohol were also common, the report found.  More than 20 percent of specimens tested positive for both benzodiazepines and opioids, while over 10 percent contained evidence of alcohol use alongside opioid consumption.

Three percent of samples were positive for all three classes of substances.

READ MORE: Mental Health Patients Receive Half of All Opioid Prescriptions

“These results highlight a troubling pattern of benzodiazepines and opioid misuse,” says the report. “The misuse of opioids is especially troubling due to risk of harm or potentially fatal overdose that is associated with concurrent use of benzodiazepine drugs and other central nervous system depressants.”

“The primary problem with the chronic use of benzodiazepines is the development of tolerance and dependence. This compounds the challenges of prescribing and using opioids and other pain relievers.”

Interestingly, there were relatively few differences in inconsistency rates when organized by health insurance type.  While Medicaid patients were somewhat more likely to show substance use issues, beneficiaries of private payers and Medicare were equally likely to use substances incorrectly.

Gender differences were also slight, with men more likely to test positive for heroin and women more likely to use non-prescribed fentanyl. 

Patients over the age of 65 were slightly less likely than those in groups aged 18 to 64 to exhibit inconsistency.  In 2016, just 42.3 percent of seniors showed issues with their substance use compared to 62 percent of young adults aged 18 to 24 and an average of just under 60 percent of other adults.

Fifteen percent of patients under the age of 10 exhibited inconsistent substance use results, but the figure is mainly attributed to young patients failing to take amphetamines or methylphenidates typically prescribed for attention deficit disorders.

Overall, a falling inconsistency rate does bode well for patients, who may be benefitting from enhanced attention to education and health IT tools that encourage safe and consistent medication adherence.

“Declines in misuse and improvements in compliance, as suggested by the trend in test results, are themselves likely due to a combination of factors, including improved patient and healthcare provider education about the risks of opioids and drug combinations; use of available tools by healthcare providers, including prescription drug monitoring programs; increased public awareness of the opioid epidemic; and FDA-sponsored Risk Evaluation and Mitigation Strategies (REMS) programs,” concludes the report.

“Well informed clinical and public policy decisions may foster measures that reduce prescription drug misuse and abuse and empower better health for each patient and society as a whole.”


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