Drug Mixing Among Most Common Types of Medication Misuse


One in 5 test results showed potentially dangerous concurrent use of opioids and benzodiazepines in 2017.

Fifty-two percent of Americans tested in 2017 misused their prescription drugs, the same rate as in 2016, but the epidemic is shifting beyond prescription opioids to encompass other drugs and dangerous drug combinations, finds a new Health Trends report released recently by Quest Diagnostics.

Drug mixing was the most common type of misuse. One in 5 test results showed potentially dangerous concurrent use of opioids and benzodiazepines in 2017. In almost two-thirds of these cases, at least one of the drugs was not prescribed. Patients who were older and in Medicare were at heightened risk. These findings were presented at PAINWeek, a national conference held in September 2018 in Las Vegas.

In addition, the report found that mixing of heroin and fentanyl—a synthetic opioid that is 50 to 100 times more potent than morphine–is on the rise. Heroin and fentanyl belong to the opioid class of drugs, and combinations of the 2 can powerfully depress respiration. Among the patient test results that were positive for heroin, 835 were also positive for non-prescribed fentanyl, nearly double the rate in 2016.

Among general care patients, who account for more than 9 in 10 of patients tested by Quest Diagnostics, the Health Trends report noted a decline in the use of non-prescribed opioids and amphetamines, as well as illicit drugs. Among patients in treatment for substance use disorders, the data show use of non-prescribed and illicit drugs surged across almost all drug classes. Additionally, for this group of patients, misuse of heroin and non-prescribed fentanyl increased nearly 400%.

The report noted that gabapentin misuse is on the rise. While use of non-prescribed gabapentin increased slightly among general care patients (up 1.8%), it surged by nearly 800% among patients in treatment for SUD, the most dramatic rate of increase of any of the drug classes tracked by Quest. Eight percent of the substance use disorder treatment population used non-prescribed gabapentin, compared to 9.6% of the general care population. While the medication is generally not addictive in itself, gabapentin can exaggerate the effects of opioids. Research shows that individuals taking prescription opioids and gabapentin concomitantly have a 49% greater risk for opioid-related death than those treated with opioids only.1

Based on 3.9 million de-identified test results performed for patients by Quest Diagnostics between 2011 and 2017, this report is believed to be the largest of its kind to provide current insights into prescription and illicit drug use and misuse in the United States based on laboratory insights.

Use of medical marijuana also rose by nearly 620%, which was perhaps not a surprising finding given the increasing availabilty. Learn more about this topic here.

The data were based on 3.9 million tests between 2011 and 2017.

"Our data suggests that some physicians and patients may be turning to alternative sources of pain relief, perhaps in response to mounting controls on opioid prescribing," report co-author Jeffrey Gudin, MD, a medical advisor to Quest Diagnostics and director of pain and palliative care at Englewood Hospital and Medical Center, New Jersey said in a press release about the findings. "This is a reminder that sharp restrictions on opioid prescribing alone will not solve the prescription drug epidemic. Until improved solutions emerge for treating chronic pain, better monitoring of patients taking prescription opioids and other potentially dangerous medications is essential."

This article was originally published by Pharmacy Times.


1 Gomes T, Juurlink DN, Antoniou T, et al. Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case—control study. PLOS Med. 2017; https://doi.org/10.1371/journal.pmed.1002396.

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