Drug Screens Show High Degree of Noncompliance
By Kristina Fiore, Staff Writer, MedPage Today
Published: April 27, 2012
The majority of patients whose doctors order a urine screen to monitor prescription drug use — usually pain meds, central nervous system agents, and amphetamines — are not using them as prescribed, a report from one of the nation’s largest diagnostic laboratories showed.
An analysis of almost 76,000 urine screens from 2011 found that in 63% of cases results did not match up with what the doctor was looking for, researchers from Quest Diagnostics found.
In 60% of those mismatches, the screen picked up drugs other than those that had been ordered, or contained additional drugs, suggesting that many patients are using drugs in “potentially dangerous combinations.”
In the other 40%, no drug was detected at all. Such noncompliance could indicate financial constraints, the researchers noted, or drug diversion.
Inconsistent results were not confined to one drug class. They showed up in 50% of patients on central nervous system agents, 48% of those on amphetamines, and 44% of those on pain medications.
But the researchers found that the inconsistencies diminished slightly on follow-up screens. Among the 6,858 patients who had repeat testing about a month later, inconsistency rates fell to 55%, they reported.
Given the nation’s persistent prescription painkiller abuse problems, the researchers said their findings “support medical recommendations that physicians perform routine urine testing to monitor prescription drug misuse” — although Quest Diagnostics would clearly benefit from an uptick in urinalysis.
Indeed, one limit of the study is that the sample may be biased because physicians may have selected those for sampling whom they suspected had a high likelihood of misuse to begin with.
Still, some organizations have recommended regular urine screens for patients on chronic opioid therapy, including Group Health Cooperative in Washington state, which has been aggressive about curbing prescription opioid abuse.
The analysis was supported and performed by Quest Diagnostics.
Primary source: Quest Diagnostics Health Trends
Quest Diagnostics “Laboratory Insights into the New Drug Epidemic” Quest Diagnostics Health Trends 2012.