Drug Misuse in America 2018
Diagnostic Insights into the Changing Opioid Epidemic

Drug Misuse in America 2018, a Quest Diagnostics Health Trends™ report, presents findings from analysis of more than 3.9 million de-identified aggregated clinical drug monitoring tests performed by Quest Diagnostics on patients in all 50 states and the District of Columbia between 2011 and 2017. To our knowledge, this report is 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.

To view the report click here.

To view the press release click here.

In this report, we reveal evolving patterns in drug misuse, specifically:

  • The rate of drug misuse remained constant, as it has for several years. The misuse rate in 2017 was 52 percent, unchanged from 2016. This suggests improvements in appropriate drug use have plateaued, and a majority of patients tested continue to present evidence of potential drug misuse.
  • Despite the unchanged rate, the nature of the drug misuse epidemic is shifting. Among patients in general care, rates of misuse of several commonly prescribed opioids and other drugs, as well as certain illicit drugs, declined over the past year. However, rates of misuse of certain drugs, including heroin and non-prescribed fentanyl, skyrocketed among individuals most at risk – those in in addiction treatment centers.
  • Drug mixing, a contributing factor to overdose deaths, is the most frequent form of misuse observed in the Quest data, and it shows no signs of abating. The highly dangerous combination of opioids and benzodiazepines is frequently found in patients tested in primary care and pain management settings.
  • Gabapentin has emerged as a potential concern, with dramatic increases observed in misuse in just one year.

For clinicians, drug monitoring can provide insights into possible forms of misuse including: substance use disorders, dangerous drug combinations, incomplete treatment, and/or “diversion” – instances where the prescribed drug is not found in the patient’s sample, suggesting the patient is possibly filling the prescription but may be diverting the drug to others or opted not to take it.

The intent of this and other Quest Diagnostics Health Trends reports is to provide insights based on objective laboratory data.

About Drug Monitoring Tests and Drug Misuse

Laboratory test results provide objective information that can assist healthcare providers with assessing patients’ use of prescribed medications, other controlled non-prescribed drugs, and illicit drugs.

In the case of clinical drug monitoring, a healthcare provider will order testing and indicate the drug or drugs prescribed for the patient as well as the drug tests to be performed. Quest Diagnostics categorizes test results as “consistent” or “inconsistent” based on the presence of drugs or drug metabolites identified through laboratory testing and their alignment with the prescription information provided by the healthcare provider on the test order.

An inconsistent result – suggesting possible misuse -- occurs when:

  • Additional drugs are found: all prescribed drugs are detected, but at least one other drug, non-prescribed or illicit, is also detected.
  • Different drugs are found: none of the prescribed drugs are detected, but at least one other drug, non-prescribed or illicit, is detected.
  • No drugs are found: none of the drugs prescribed for the patient are detected and neither are any non-prescribed or illicit drugs.

A non-prescribed drug refers to a drug that is a prescription drug but which was not prescribed for the patient as indicated by the healthcare provider on the test order.

Inconsistent results can reflect potential problems for the patient and the healthcare system. Drug combining, whether involving prescription or illicit drugs, can lead to dangerous drug combinations and interactions. Test results that show evidence of a non-prescribed drug likely indicate the patient is using the drug without the benefit of a physician’s oversight. Failure to take a prescribed drug may contribute to healthcare waste, ineffective treatment, and the potential for unintentional or criminal diversion.

For more information about Quest Diagnostics Drug Monitoring for clinicians, visit www.QuestDrugMonitoring.com