Most primary care physicians, 62%, fear the opioid drug crisis will be traded for a new prescription drug crisis. And nearly three quarters worry that chronic pain patients will turn to illicit drugs if they do not have access to prescription opioids, according to a new Health Trends report from Quest Diagnostics.
Seventy percent of primary care physicians wish they had more training on how to taper their patients off opioids.
The report provides insights into physicians' concerns about patient misuse of prescription and other drugs, as compared with the results of lab data: Half of test results of patients prescribed an opioid or other controlled medication show signs of drug misuse and one in four show signs of potentially dangerous drug mixing.
The new research includes findings from a new online survey of 500 U.S. primary care physicians, conducted by The Harris Poll, and commissioned by Quest Diagnostics in consultation with Center on Addiction, about the use of controlled prescribed medications such as opioids, amphetamines, and benzodiazepines and illicit drugs.
It juxtaposes the survey responses with an analysis of more than 4.4 million de-identified, aggregated drug monitoring test results ordered by physicians for patients prescribed controlled medications and performed by Quest Diagnostics between 2011 and 2018.
The intersection of these two data sets reveals the contrast between physician expectations about patient drug use and the evolution of the drug epidemic, and actual patient behavior. It comes amidst a national drug crisis that claimed an estimated 68,500 lives last year.
WHAT'S THE IMPACT
Among the key findings is that physicians may be overconfident in their ability to recognize prescription drug misuse. Fifty-one percent of patient test results showed misuse of a controlled medication or other drugs in 2018, a rate that is virtually unchanged from a misuse rate of 52% in 2017 and 2016. Yet, 72% of physicians trust their patients to take their controlled substances as prescribed.
Nearly all physicians, 95%, feel confident in their ability to discuss risks of prescription drug misuse with patients, but only 55% said they actually discussed potential misuse with most of their patients who were prescribed controlled substances in the past month.
Fifty-three percent of physicians, meanwhile, believe fewer than 20% of patients misuse their controlled substances through drug mixing. But 24% of all patient test results in 2018 showed signs of combining prescription medications with other non-prescribed drugs or substances, including illicit drugs.
Drug combinations involving fentanyl are also prevalent. Among patient test results that were positive for heroin, 64% were positive for non-prescribed fentanyl. Among patient test results that were positive for cocaine, 24% were positive for non-prescribed fentanyl. The company's testing detects prescription forms of fentanyl, not illicitly manufactured fentanyl, so it is possible that actual rates of fentanyl drug combining are higher.
Meanwhile, there has been concern raised about a drug called gabapentin which has emerged as an alternative to opioids. Gabapentin, an anticonvulsant that can be used to relieve neuropathic pain, has recently been classified as a controlled substance in some states. Misuse of this drug may be increasing.
Almost 80% of physicians say that in an effort to avoid prescribing opioids for the treatment of chronic pain, they often prescribe gabapentin to their patients. But lab data shows a 40% increase in non-prescribed gabapentin misuse in just the past year, with 13.4% of patient results showing this type of misuse -- making gabapentin the most commonly detected non-prescribed controlled medication in 2018.
WHAT ELSE YOU SHOULD KNOW
Many physicians have called for additional training and education regarding substance use disorders. At least 7 out of 10 physicians would like more information on how to monitor for prescription drug addiction, wish they had more training on what to do if a patient shows signs of addiction or wish they had more training on how to taper their patients off opioids.
A full 88% say prescription drug monitoring (involving laboratory testing) is critical to helping identify patients who may be misusing prescription drugs. And 92% believe prescription drug monitoring will increasingly become the standard of care when prescribing controlled substances, although 33% worry about offending patients.
In addition, 77% of physicians say they believe the stigma surrounding prescription drug addiction impairs patient care.
THE LARGER TREND
While medication-assisted treatment can help people who are addicted to opioids, the three drugs approved by the Food and Drug Administration are underused, according to a review of current medical data on opioid addiction in the U.S. The review appears in the October issue of Mayo Clinic Proceedings.
Along with addiction counseling, the drugs naltrexone, buprenorphine and methadone all have a place in treatment for opioid use disorder, the authors said. Dr. Tyler Oesterle, medical director of Mayo Clinic Health System's Fountain Centers drug and alcohol treatment programs and the lead author, said evidence of the three drugs' effectiveness in treating opioid use disorder is well-established.