More than half of Americans tested by Quest Diagnostics in 2017 misused prescription drugs, a statistic that has remained relatively flat and suggests that medication adherence is more difficult as the opioid epidemic swells.
The misuse rate — meaning tests reveal additional drugs (non-prescribed or illicit), different medications than prescribed, or no prescription or illicit drugs — was 52% in 2017 and 2016, and has remained relatively stagnant since 2013, according to Quest Diagnostics' analysis of 3.9 million clinical drug monitoring tests administered between 2011 and 2017.
Most of the misuse stemmed from positive results for non-prescribed or illegal drugs in addition to their prescriptions.
"We are seeing the efforts of various healthcare organizations and government agencies pay off through a decline in the deaths related to prescribed pain drugs, but we have also seen a meteoric rise in fentanyl," said lead author F. Leland McClure who is a director at Quest.
The report also broke down medication adherence by general care patients who visit a primary care physician or pain specialist. Rates of non-prescribed opioid and amphetamine drug use as well as illicit drug use declined from 2016 to 2017, indicating that physician, health system, insurer, regulatory and legislative efforts to limit opioid use have worked.
Although, the rate of non-prescribed and illicit drugs surged among patients tested in treatment centers for substance abuse. Non-prescribed fentanyl and heroin use increased nearly 400% from 2016 to 2017, although the drug monitoring didn't account for synthetic fentanyl, so the rates are likely much higher. Increases in fentanyl use among treatment center patients were especially pronounced in individuals aged 18 to 44, increasing from 3.4% in 2016 to more than 29% in 2017, while positive heroin tests rose from 0.8% to 9.9%.
"Providers have done better jobs on treating the right patients with the right medicines, but there are limitations on how they can use or how often they check prescription drug monitoring databases," said Dr. Jeffrey Gudin, director of pain management and palliative care at Englewood (N.J.) Hospital and Medical Center, medical advisor for Quest and a co-author of the analysis. "Now we have a huge population of recreational abusers."
The use of gabapentin, which is often prescribed to treat seizures and psychiatric conditions, was also on the rise. The drug can also be taken to exaggerate the effects of opiates.
In 2017, 9.5% of patients tested by Quest showed evidence of non-prescribed gabapentin. Use surged eightfold among patients in substance abuse treatment settings.
"Prescription drug monitoring programs are important to better understand prescribing patterns, but they don't tell us what patients actually use and the extent they are misusing medications," McClure said. "And it is quite sobering."
Getting patients to take their prescriptions is critically important as the healthcare industry looks to improve outcomes, streamline care and cut costs. About 10% of hospitalizations and 125,000 deaths annually in the U.S. stem from not taking medications as prescribed, according to one estimate. That can translate to as much as $289 billion per year in excess healthcare costs.
The healthcare industry needs to develop and support opioid alternatives for chronic pain management, Gudin said. In the meantime, the industry as a whole needs to better monitor patients taking prescription opioids and optimize prescription drug monitoring programs to track patient behavior, he said.
"This is a reminder that sharp restrictions on opioid prescribing alone will not solve the prescription drug epidemic," Gudin said.