A novel report on US opioid misuse melds results from a Harris Poll of 500 primary care physicians with Quest Diagnostics data on 4.4 million drug monitoring tests.
Primary care physicians are concerned. 83% agree that because of the opioid crisis, it is considerably harder now to treat patients suffering from chronic pain and 70% wish they had more training on how to taper their patients off opioids.
PCPs are reluctant to take on new patients taking opioids for chronic pain. 83% agree the opioid crisis has made it considerably harder to treat chronic pain patients and 72% feel that the trade-off for a decrease in opioid-related deaths will be a greater number of patients whose pain is not properly managed.
PCPs may be overconfident in their ability to recognize Rx drug misuse. 95% are confident in their ability to discuss risks of prescription drug misuse and 80% are confident in their ability to recognize the signs of Rx drug misuse based on in-office patient interaction BUT only 55% said they actually discussed potential misuse with most of their patients who were prescribed controlled substances in the past month.
Physicians seem less concerned about gabapentin vs opioids for pain. 85% have prescribed gabapentin vs 62% who have prescribed opioids in the past 6 months for chronic pain. 63% believe that <10% of patients who are prescribed gabapentin misuse it. BUT there was a 40% rise in misuse of gabapentin in one year.
Gabapentin was the medication most commonly used without a prescription in 2018. 13% of patient test results showed evidence of non- prescribed gabapentin in 2018, after marijuana and alcohol (both 14%).
Surveyed physicians expect that more of their colleagues will recommend alternative treatments: 85% see peers suggesting naturopathic treatments, eg, acupuncture, massage, PT; 58% expect that marijuana will be recommended for chronic pain.
Physicians may underestimate drug mixing. Prescription drug mixing is the most prevalent form of drug misuse observed in laboratory data and consists of combining Rx medications with other drugs, including illicit drugs, other Rxs, or alcohol. 53% believe that <20% of patients misuse their controlled substance Rx through drug mixing BUT 24% of patient lab test results in 2018 showed signs of combining Rx with non-Rx drugs, alcohol, illicit drugs.
Fentanyl enters the mix. 64% of patient test results that were positive for heroin also were positive for non-prescribed fentanyl. 24% of patient test results found positive for cocaine were also positive for non-prescribed fentanyl.
On prescription drug monitoring – positives and negatives. 88% say Rx drug monitoring is critical to help identify patients misusing the medications. 92% believe monitoring will become the standard of care when prescribing controlled substances. However, 33% fear offending patients if they require Rx drug monitoring.
Physicians are eager for education. 70% wish they had more training on how to taper opioids. 75% want more training on what to do if a patient shows signs of misuse or addiction. 76% would like more information on how to monitor for Rx drug addiction.
The Centers for Disease Control and Prevention reported in 2018 a decline in the number of drug overdoses-the first reduction recorded in more than a decade. But new a report published by Quest Diagnostics suggests the danger is not over, pointing to increases in deaths from synthetic opioids, prevalent illicit drug mixing, an uptick in use of stimulants eg, cocaine, among other trends.The report, Drug Misuse in America 2019: Physician Perspectives and Diagnostic Insights on the Evolving Drug Crisis, combines responses from 500 primary care physicians to a survey on use of controlled prescribed medications and illicit drugs with analysis of more than 4.4 million deidentified aggregated clinical drug monitoring tests performed by Quest for patients from all 50 states from 2011-2018.The slides below share highlights of results, offering what the report calls "...insights into the complexity and tenacity of the drug misuse crisis."