Can Physicians Spot Prescription Drug Misuse?

NATIONAL HARBOR, Md. -- Primary care physicians may be overconfident in their ability to recognize prescription drug misuse, a researcher suggested here.

An analysis that juxtaposed survey data from 500 primary care physicians with over a half million drug test results showed that nearly three-quarters of doctors trusted their patients to take medications as prescribed, but half of specimens showed signs of misuse, reported Jeffrey Gudin, MD, of Rutgers New Jersey Medical School in Newark, at the American Academy of Pain Medicine annual meeting.

The survey found that while most physicians expressed confidence in their ability to discuss drug misuse, just over half actually broached the subject and a third worried they might offend patients.

Most doctors agreed it was "considerably harder now to treat patients suffering from chronic pain," and 81% said they were reluctant to accept new patients who currently are prescribed opioids. About 62% feared a new drug crisis and 72% thought patients would turn to illicit drugs if they couldn't get prescription opioids, Gudin noted.

These findings highlight the struggles physicians face treating pain patients, Gudin said. "Physicians are on the front-line of this crisis, but may not be equipped to recognize prescription drug misuse," he told MedPage Today.

"As many physicians begin to tighten up opioid prescribing, they turn to gabapentin as an alternative," he added. "A novel finding of this study is that gabapentin is emerging as an alternative pain therapy to opioids, but lab tests show misuse of non-prescribed gabapentin is accelerating."

The analysis incorporated data from a 2019 online Harris Poll survey of 500 primary care providers and the results of 545,527 prescription drug monitoring tests performed throughout the U.S. in 2018 by Quest Diagnostics. Samples from drug rehabilitation clinics and addiction specialists were excluded. Quest Diagnostics has maintained a database of de-identified clinical laboratory results since 2011.

The drug tests reflected non-prescribed gabapentin use in 13.4% of samples, up 40% from a year ago, Gudin noted. "Based on an analysis of our laboratory data, 2018 marked the first time gabapentin was the most commonly detected non-prescribed controlled medication in test results," he said.

Overall, a quarter of test results showed signs of mixing prescribed and non-prescribed drugs. Opioid-benzodiazepine combining was found in more than 17% of specimens; in 64% of those, at least one of the drugs was not prescribed. Of samples that tested positive for heroin, nearly two-thirds also showed non-prescribed fentanyl.

Limitations of the study include possible selection bias and geographic disparities. The researchers could not validate or contextualize drug test results with medical records. Some patients may have been referred to testing because their doctors suspected misuse, and some healthcare providers may have neglected to indicate all prescribed drugs a patient was taking.

Because results from drug rehabilitation clinics and addiction specialists were excluded from the study, drug misuse rates may be different than what this analysis shows, the researchers added.