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Primary Care Physicians Could Use More Training on Patient Misuse and Abuse of Prescriptions

October 29, 2019
Results from Quest Diagnostics’ 2019 Health Trends report, including a look at opioid tapering.

Quest Diagnostics, headquartered in Secaucus, NJ, recently surveyed 500 US primary care physicians (PCPs) about their patients’ use of controlled prescribed medications, including opioids, amphetamines, benzodiazepines, and illicit drugs. The results appear in their new report, "Drug Misuse in America 2019: Physician Perspectives and Diagnostics Insights on the Evolving Drug Crisis."1

Researchers compared the responses to an analysis of more than 4.4 million de-identified aggregated drug monitoring test results ordered by physicians for patients prescribed controlled medications and between 2011 and 2018; all tests were performed by Quest Diagnostics. Key findings are detailed below.

PCPs worry about an impending new drug crisis:

  • 62% fear the opioid drug crisis will be traded for a new prescription drug crisis
  • 72% worry that patients living with chronic pain will turn to illicit drugs if they do not have access to prescription opioids

PCPs would like more training on tapering and on recognizing signs of addiction:

  • 70% wish they had more training on how to taper their patients off opioids
  • 76% would like more information on how to monitor for prescription drug addiction
  • 75% wish they had more training on what to do if a patient shows signs of addiction

The report is the first to juxtapose insights from both nationally representative, objective de-identified laboratory data and survey responses from PCPs about the use of controlled prescribed medications and illicit drugs in the US. (Image: iStockPhoto)

At the same time, 72% of physicians said they trust their patients to take their controlled substances as prescribed and a majority (95%) stated that they feel confident in their ability to discuss risks of prescription drug misuse with patients. In fact, 55% said they discussed potential misuse with patients to whom they prescribed controlled substances in the past month.

Interestingly, 53% of those taking the survey said they believe that less than 20% of patients misuse controlled substances through drug mixing. In comparison, drug monitoring test results from Quest indicated that 24% of patient test results showed signs of potentially dangerous drug mixing. In addition, the de-identified testing demonstrated that:

  • 51% of patient test results showed misuse of a controlled medication or other drugs (in 2018)
  • Among results testing positive for heroin, 64% were positive for non-prescribed fentanyl
  • Among results testing positive for cocaine, 24% were positive for non-prescribed fentanyl
  • There was a 40% increase in non-prescribed gabapentin misuse in 2018 (13.4% of patient results).

Primary care doctors were also asked for their thoughts on the current and future landscape of prescription drug monitoring. Quest reported that:

  • 83% agree that, because of the opioid crisis, it is considerably harder now to treat patients suffering from chronic pain
  • 77% believe the stigma surrounding prescription drug addiction impairs patient care
  • 88% believe prescription drug monitoring is crucial to helping identify patients who may be misusing prescription drugs
  • 92% believe prescription drug monitoring will increasingly become the standard of care when prescribing controlled substances.

Dr. Jeff Gudin, Co-Editor-at-Large for PPM and a consultant to Quest Diagnostics noted that the findings of this year’s report should enlighten prescribers to the current relevant risks of drug misuse as it relates to chronic pain management. “Unfortunately, the results presented reinforce the notion that dangerous practices, such as drug combining, are still occurring and should empower clinicians to educate themselves and their colleagues on drug testing and patient counseling about inappropriate drug use. Although testing is recommended by the CDC and other guidelines, many clinicians are still not screening patients when prescribing controlled substances. Screening tools and Prescription Drug Monitoring Program databases are helpful, but drug testing remains the only objective measure of what a patient has actually consumed.”

For a video guide on current best practice in drug monitoring, see PPM’s video series and FAQ: https://www.practicalpainmanagement.com/resource-centers/quest-monitoring/introduction

Last updated on: October 29, 2019
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