Prescription Drug Misuse Declines in U.S.

Prescription Drug Misuse Declines in U.S.

A new study by one of the nation’s largest drug screening companies suggests that the misuse of opioid pain medicines and other prescription drugs may be declining in the United States.

urinetestIn an analysis of over 1.4 million urine drug tests, the Quest Diagnostics Health Trends study found that the number of patients misusing their medications fell from 63% in 2011 to 55% in 2013.

Drug misuse rates were greater than 50% for both men and women, and for all age groups except patients over the age of 64.

“Prescription drug misuse remains at alarming levels, with more than one in two patients putting their health at risk through inappropriate and potentially dangerous misuse of drug therapies,” said F. Leland McClure, PhD, a study investigator for Quest Diagnostics (NYSE: DGX).

“But the multi-year analysis yielded some positive findings, including significant decreases in certain states with comprehensive prescription drug abuse programs. These findings indicate that, armed with the right strategies and tools, policymakers and health professionals are making headway against the prescription drug epidemic.”

Five states that cracked down on “pill mills” or implemented prescription drug abuse prevention and monitoring programs (PDMPs) showed the highest rates of decline in drug misuse. Florida, Georgia, Kentucky, New York and Tennessee had an average decline of 10.7% in prescription drug misuse, nearly 2.5 times higher than the average decline for all other states combined.

Patients in the Quest study were screened for up to 26 commonly prescribed and abused drugs, including opioid pain medications, central nervous system medications, and amphetamines, as well as some illicit drugs such as marijuana, cocaine, and heroin.

Drug misuse was very broadly defined in the study and includes “inconsistent” results – such as a patient not taking a drug that was prescribed for them. In 2013, no drugs were found in 43% of the inconsistent cases, an increase from 40% in 2011.

“Many patients do not take their prescribed drugs. Patients may cease taking a prescription due to a concern of side effects or because their pain had subsided,” the Quest report states. “Others may not take their drugs perhaps due to financial constraints or through sale of their medication.”

The report does not mention that many pain patients, particularly in states such as Florida, have difficulty getting their opioid prescriptions filled at pharmacies.

“Healthcare practitioners need to know that their patients are not following their instructions,” said Michael R. Clark, MD, associate professor and director, Chronic Pain Treatment Program, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Hospital.

“While inconsistency rates have decreased over time, patients are still substituting, supplementing, and diverting their prescribed controlled substances. In fact, over recent years, patients are supplementing their prescribed medications with increasing amounts of non-prescribed substances.”

The study’s findings support research released earlier this month by the Centers for Disease Control and Prevention (CDC), which found a 23% decrease in drug overdose deaths in Florida between 2010 and 2012, with similar improvements in New York and Tennessee.

Opioid prescribing rates remain very high in Tennessee and Kentucky, according to the CDC.

“Certain states have taken to heart the need to address prescription drug abuse, with proactive measures that involve physician and patient education as well as PDMPs and appropriate testing,” said Harvey W. Kaufman, MD, a study investigator and senior medical director, Quest Diagnostics.

“Prescription drug medications such as opioids and amphetamines can be enormously effective therapies, and for many people a source of better health outcomes, such as reduced pain. We need to find a balance between ensuring patients get the medications they need and preventing them from developing addiction and other health problems. Greater public education of the dangers of inappropriate prescription drug use is critical in this effort.”

Authored by: Pat Anson, Editor

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Kurt W.G. Matthies

Red,

Oh, and don’t I know it.

The only studies I have found show OIH in rat tissue, yes, and very isolated cases in the clinical world, here and there.

I have my own theory — that we find OIH in high-level opioid users without any chronic pain syndrome — but it’s just a theory. Will some researcher pick it up and test it?

However, in my discussions with clinicians, I have heard stories of OIH in humans — and they’re ugly.

One of my former pain doctors has been in practice since the early 1980s. There was a time he worked with people like Portenoy to publish pain research, and is a well-known and highly respected expert in chronic pain and its treatment.

In his practice he mentioned coming across three (3) cases of OIH in over 25 years of practice with literally thousands of patients.

It’s hard to draw an analogy. Like Big Foot, people have seen OIH but have little evidence. It is today’s pain management boogie man, feared, but not well understood.

Red

Kurt, it my interest you to know that OIH has been poorly studied in human beings. Most of the evidence in support of the OIH phenomenon comes from studies on rats. Kind of a big leap, isn’t it?

Red

BL, I believe the real problem is irresponsible dopers who steal their relatives’ legitimate prescriptions, and buy pills off the street. These are people who are willingly and knowingly trying to get high. I don’t think that “accidental addiction” is as common people make it out to be.

As for lifestyle changes, what a joke. I have a connective tissue disorder. It is genetic. It’s not caused by weight gain, lack of exercise, or smoking. It causes me severe chronic pain. In the four years that I have lived in my current city, I have vigorously (well, as vigorously as possible) sought help from physical therapists, orthopedists, and other people who I hoped could recommend ergonomic changes, adaptations to activities of daily living, and adjustments of body mechanics to me. I was sorely disappointed. Almost every medical professional where I live has a “pass the buck” attitude towards patients with genetic problems and/or chronic pain and was completely unwilling to be bothered. “I can’t help you” is the sentence that I have heard most. I have even been further injured by physical therapists who failed to understand my condition and were not interested in reading materials that I gave them to help them learn how to treat me! If I did not have my primary care doctor, who prescribes my pain medication, then what would I do? How would I get out of bed? How would I care for myself or my pets? What would I do when the pain will not let me sleep? Since nobody else is giving me any options besides medication, what other choice do I have? Tell me that.

By the way, it’s “addictive,” not “addicting.” As Weird Al says, I hate these word crimes.

People that do not have pain DO NOT understand . I am an RN. I tried to have empathy and for years I just followed Dr.s’ orders giving out pain meds. (They even prescribed placebo injections! I feel so bad now about that.) For me it started with knee pain. I would come home from work and lay on the floor with my legs up on a chair. I tried ASA every 4 hours. Tylenol never worked. I learned about ibuprofen. 2 pills every 4 hours, then over time 3 pills. Then I started working in an ambulatory surgery setting and learned about max doses for ibuprofen. Then over years I would have one drink after work, then another. Alcohol helps with pain.
ACL reconstruction, helped some. 15 years later and maxing out ibuprofen with some beers, I could not walk thru a grocery store with a grocery cart for support. One knee replacement than the other, I had high hopes I would be all better. I still could not walk well. One knee revision 4 years and hours of physical therapy ,I was then told I needed a hip replacement. I learned that a congenital hip deformity ( mild) had caused all the years of difficulty. I do move easier now. I do not need a cane. I still take ibuprofen 800mg every 8 hours or else I do not feel like moving. Low level pain but it still discourages me from walking as much as I would like. If I max the dosage of ibuprofen I developed GERD symptoms that sent me to the ER once thinking I was having an MI. Joint replacememts help to decrease pain and increase mobility but are not perfect. I have a small reset e of Vicoden that help me do more on my feet . I ration them because I know how reluctant doctors are to prescribe them. My doctor gave me a steroid injection last year in my one remaining natural hip. It helped great for the first month and then slowly wore off. I am worried about the future. I have seen my mother progress to a riding scooter and just sitting in a chair all day. They took away her Vicoden, that helped her to keep moving. I guess I may have to ” doctor shop” one day. I want to keep moving. I would love to go to the Smithsonian museums but ” the walking”. I tried Disney World with my grandchildren but ended up using a wheel chair. My grandkids loved it, since they allowed us to go in a special line! I do not like wheelchairs. I avoid shopping malls or anywhere I have to stand in line. Standing still in line is the worst. Anyway, those of us with pain just want to be able to do more normal activities again. Even if it means taking stronger medications. Just wait till you are in our shoes, you will then understand.

Kurt W.G. Matthies

Trudy, Good thinking. Regulators get more support when there is a bogey man out there frightening the populous.

Pain patients do “abuse” their meds, if you change the term abuse to refer to taking more than prescribed, especially breakthrough medications.

Why? Because they’re under medicated.

Another bogey man who’s been hanging around the anti-drug propaganda department is opioid induced hyperalgesia or OIH.

Supporters of OIH claim that 200mg morphine daily equivalent causes OIH (on very little research, mind you.).

Many chronic painers find that a 200mg morphine daily equivalent of long-acting medication barely adequate to help them get to the toilet in the morning.

So, if I require an extra 8 or 12 or 16 mg of hydromorphone just to get to my medical appointment 50 miles away, and back, and do the pharmacy crawl for half a day trying to fill my Exalgo and hydromorph Rx, I’m “abusing” my medication.

If I’m waiting months for my insurance company to approve an RFA procedure that has worked repeatedly in the past to lower my pain by maybe 50%, and I have to increase my opioid analgesics to get to the grocery, pick up my mail, sit at this computer and counsel my pain buddies — I’m abusing my opioid medication.

I’ve been using daily opiates for over 20 years — since the first long acting formulations hit the stores. I used PRN lower strength opiates for 10 years prior to needing the 24/7 dosing.

I know how to manage my opioid pain medication, but with their definition of medication abuse, I’m an abuser.

Words have meaning. When we change the meaning of words to benefit our agenda, we can change a lot more than a dictionary entry — we can change the hearts and minds of a populace.

BL

I believe pain meds are abused just like alcohol, marijuana & other drugs. But, I do not believe that chronic pain patients are to blame. I do believe that the drs weren’t as careful as they should have been in the past in prescribing pain meds for every ache & pain. And when constantly increasing the pain meds instead of insisting patients alter their lifestyle. If a patient isn’t going to be responsible with the medications they are prescribed, they shouldn’t have them.

Marijuana can be addicting just like alcohol and other drugs. Marijuana, alcohol and other substances can also be misused.

Toni Kresen

To Trudy McGee:

I wholeheartedly and definitively agree! Also – “Big Pharma” is running scared about Medical Marijuana. IF opioids are SO abused then WHY did FDA approve PURE opioid prescription Zohydro in capsule w/ NO “deterrent”. ALL hype – just like “Refer Madness”!!! People in debilitating chronic pain cannot get pain meds needed & so have to remain DISABLED & in HIGH CHRONIC NEVERENDING PAIN but “addicts” still can get them – from the STREETS!!!

Trudy McGee

Just curious. What if we really don’t have as big a problem in the US of abuse of pain meds? What if all this hype that has come out in the last few years is merely the DEA needing a new scape goat? What if this is the “marijuana epidemic that started the DEA in the 20’s? Remember Reefer Madness? WHat if this is just the DEA’s way of keeping themselves in a job? I am very active on many, many pain sites, and I rarely deal with anyone who abuses their meds. If that is an indication of pain patients, then their statistics are really off, and perhaps they are not being truthful.

Just something to think about.