Many Americans Misusing Prescription Drugs

Blood tests show that Americans may deviate from prescription drug regimens.

A new blood analysis study suggests that many Americans may be misusing their prescriptions. The analysis from Quest Diagnostics found that a majority of test results of patients taking prescription drugs pointed to misuse, including dangerous combinations of drugs.

The Quest Diagnostic Health Trends study included de-identified data from 3.4 million prescription medication monitoring tests. Blood analysis may be ordered by physicians to monitor patients for potential drug misuse and illicit drug use, according to Quest.

In 2011, Quest reported that 63% of the tests indicated inconsistencies, which means that patients may be taking prescription drugs in a way that conflicted with their physician’s instructions.

Although other studies suggest that drug misuse has declined recently, Quest found that 52% of test results indicated potential misuse in 2016. Despite the 11% decrease between 2011 and 2015, misuse prevalence remains high.

"Over the past several years, federal and state government, clinician organizations, public health advocates and providers have all launched campaigns to educate the public about the perils of prescription drug misuse, which hypothetically should have yielded a significant rate of improvement. Yet our study shows that every other American tested for possible inappropriate use of opioids and other prescription drugs is potentially at risk," said lead author F. Leland McClure, PhD, MSci, F-ABFT, director, medical science liaison, medical affairs, Quest Diagnostics. "This finding is rather shocking, and speaks to the challenges of combating the nation's drug misuse epidemic."

Misuse rates were high among a majority of age groups and both genders; however, misuse rates among adolescents decreased from 70% in 2011 to 29% in 2016, according to the study.

Compared with the general population, misuse rates among men and women of reproductive age were slightly higher. The authors note that concomitant use of opioids and benzodiazepines may reduce fertility in men and cause birth defects to the fetuses of pregnant women.

The investigators also noted that many patients are taking potentially dangerous combinations of drugs.

The authors found that more than 33,000 tests looked for opioids and benzodiazepines in 2016. Approximately 10% of tests were positive for opioids and alcohol, while 3% were positive for all 3 substances, according to the study.

More than 20% of the tests were positive for opioids and benzodiazepines, a combination the FDA issued a warning against due to the significant risk of sleepiness, respiratory depression, coma, and death. Due to these risks, the FDA also issued a boxed warning for the drugs. The CDC reports that benzodiazepines are involved with more than 30% opioid-related deaths.

Quest also found that 19% of tests were positive for heroin and fentanyl in 2016. This drug combination increases the risk of overdose-related death due to the high potency of fentanyl.

These results highlight the need for additional approaches to improve medication adherence and reduce prescriptions for both opioids and benzodiazepines.

"Accidental drug overdose is a serious problem in the United States. It appears from our analysis that many patients may be at risk of overdose or other adverse health effects caused by concurrent use of opioids including fentanyl and other drugs such as benzodiazepines," said Jeffrey Gudin, MD, medical advisor, Quest Diagnostics. "Opioid prescribing guidelines issued by the CDC in 2016 advocate for drug testing patients prescribed opioids to monitor for potential misuse. These guidelines also recommended limiting benzodiazepines simultaneously to avoid dangerous drug interaction. Careful vigilance by prescribing physicians may help to offset some of the risks for patients who may be unaware of the dangers of combining these and other medications."