Quest Says Many Americans Are Misusing or Abusing Prescription Drugs

The majority of Americans who take prescription drugs are misusing them, according to a new comprehensive survey by Quest Diagnostics.

Quest, like many laboratories, has an extensive drug monitoring and compliance business. The New Jersey-based company analyzed 3.143 million de-identified test results over several years from 49 states and the District of Columbia to determine the particular issues challenging this patient population. It has performed similar extensive surveys on public health issues such as the prevalence of diabetes and how well it is being managed by specific patient populations.

The results from the drug survey were sobering: 54 percent of patients misused their drugs in one way or another last year. That's up from 53 percent in 2014, although down from 63 percent in Quest's 2011 survey. The 18-24 age group was the likeliest to have an issue of misuse, although 46 percent of those over the age of 65 also had issues. Medicaid enrollees were the likeliest to have compliance issues, but the rates among enrollees in private plans and Medicare were also relatively high.

The report comes as many parts of America are battling an epidemic of abuse involving prescription opioid painkillers. According to the Centers for Disease Control and Prevention, the number of overdose deaths from prescription opioids has quadrupled since 1999, totaling about 165,000 by 2014. About 1,000 people are treated in hospital emergency departments every day for the abuse of prescription painkillers.

Earlier this year, the CDC issued recommendations about when to prescribe opiate painkillers. Physicians are only supposed to issue a prescription if the benefits outweigh the risk to the patient, and if the patient is tested for the presence of drugs before and after a prescription is issued.

Nevertheless, the epidemic of prescription painkiller abuse has been a boon of sorts for the laboratory sector. There have been many startup labs handling drug monitoring in recent years. For national labs such as Quest, drug monitoring has been among its fastest growing lines of business.

"The key takeaway from this massive, nationally representative analysis is that despite some gains, a large number of patients use prescription drugs inappropriately and even dangerously," said co-researcher Harvey W. Kaufman, M.D., a Quest senior medical director. "The CDC's recent recommendations to physicians to carefully weigh the risks and benefits of opioid drug therapy are a step in the right direction, but clearly more needs to be done to address this public health crisis."

According to the Quest study, the biggest issue involving misuse of prescriptions is the presence of additional drugs that were not prescribed: This occurred in 45 percent of those patients who were having compliance issues. That's up from 32 percent in 2011 and 35 percent in 2014.

Benzodiazepines, a class of anti-anxiety medications commonly marketed under the Xanax and Valium brands, were the likeliest drug to be misused, according to the study, followed by opiates and oxycodone, a time-released painkiller.

Among those who tested positive for opiates such as heroin, nearly 29 percent also tested positive for benzodiazepines, which can amplify heroin's depressive effects on the nervous and respiratory systems. More than 90 percent of the time, the benzodiazepines were not prescribed by a physician.

"For some patients, opioids and sedatives are co-prescribed which is of concern. The discovery that a growing percentage of people are combining drugs without their physician's knowledge is deeply troubling given the dangers. Perhaps patients do not understand that mixing even small doses of certain drugs is hazardous, or they mistakenly believe prescription medications are somehow safe," said co-researcher F. Leland McClure, a Quest medical affairs director.

Among children up to the age of 17, amphetamines were most likely to be misused. In most cases, the drug was prescribed as a treatment for attention deficit disorder.

The rate of drug use was particularly high for patients who had tested positive for hepatitis C. More than two-thirds of those with a positive diagnosis for the disease had additional drugs in their systems that had not been prescribed. The rates of the presence of fentanyl and heroin were nearly twice as high as the average in the rest of the study.

Takeaway: Quest Diagnostics' study of its drug testing division continues to show significant drug abuse issues among a large population of Americans.