Use of so-called “full-spectrum” formulations of cannabidiol (CBD) products can cause users to test positive for THC, the component of marijuana that causes euphoria, according to an open-label study published in JAMA Psychiatry.

The United States Drug Enforcement Administration has solicited bids from software contractors for a new “Pharmacy Prescription Data” system that would collect deidentified data on at least 85% of all Schedule II through V prescriptions across the US, according to a request for proposal issued September 2, 2020.

If you are prescribing medications for patients with chronic pain or substance use disorder (SUD), a clinical drug monitoring program should be part of your routine practice. Without it, you are basically “flying blind” and may putting your patients at increased risk. With it, you have the objective information you need to keep your patients safe throughout their treatment.

Can a woman who uses a controlled substance during pregnancy be prosecuted for child abuse? Must health care workers report substance use during pregnancy? The answer to these questions and others varies from state to state, with little consistency, according to a comparison of state laws and policies by Pro Publica, the non-profit investigative journalism organization. 

The Drug Enforcement Agency (DEA) has made several important changes to the rules that govern prescription of controlled substances, in response to the public health emergency posed by the COVID-19 pandemic.

Clinical drug testing fell by over 50% in spring of 2020 due to the COVID-19 pandemic, according to a new study from Quest Diagnostics®. At the same time, the proportion of samples testing positive for dangerous illicit drugs and drug combinations rose.

In mandated tests of employees in safety-sensitive jobs, marijuana had the highest rate of drug positivity, followed by opioids and amphetamines, according to the 2020 Quest Diagnostics Drug Testing Index™ report. The report includes data from over 2.4 million tests from January to December 2019 of workers in safety-sensitive positions undergoing federally mandated drug tests. These include workers in the airline, transportation, and marine industries, among others.

The COVID-19 pandemic appears to have reduced the number of patients receiving treatment at medication-assisted treatment (MAT) facilities, according to data from a new study from Quest Diagnostics analyzing clinical drug test results before and during the pandemic.

While non-prescribed use of several drugs, including fentanyl, increased with the onset of the COVID-19 pandemic, non-prescribed use of gabapentin fell, according to a new study from Quest Diagnostics®. The study compared non-prescribed prescription and illicit drug positivity before and during the pandemic.

A small double-blind study has demonstrated that kratom—a southeast Asian herb traditionally chewed as a stimulant to combat fatigue—has analgesic properties in regular users. Twenty-six men in their early to mid-20s who had used kratom regularly for several years received kratom or placebo in a randomized, blinded order after a 10- to 20-hour discontinuation period. Pain tolerance was measured in an ice bath, with time from pain onset to withdrawal as the primary endpoint.

The rate of drug test positivity in the workforce hit a 16-year high in 2019, according to data from the annual Quest Diagnostics Drug Testing Index™ report. Data for the report are drawn from nearly 9 million urine drug tests performed during the year by Quest, the world’s leading provider of diagnostic information services. Overall, 4.5% of samples tested indicated use of an illicit drug.

Kratom is an herb derived from the leaves of the kratom tree (Mitragyna speciosa) indigenous to Southeast Asia. The leaves have traditionally been chewed as a stimulant to combat fatigue. In the United States in recent years, it has been sold as an “herbal supplement” with claims that it boosts mood and energy, and relieves pain.

Kratom may be the most common recreational drug you’ve never heard of. Whether you pronounce it “CRAT-em” or “CRATE-em,” kratom has emerged recently as a drug of concern in the United States. Legal in some states, illegal in others, this drug may have the potential to be an effective medication in the future, but is also being widely used recreationally without any…

The COVID-19 pandemic has disrupted the delivery of care across the country, including for patients receiving chronic pain medications and medication-assisted treatment (MAT) for substance use disorder. To minimize these disruptions, federal agencies have made important exceptions to standard prescribing regulations, as outlined in a previous blog.

The COVID-19 pandemic has likely contributed to an increase in opioid-related deaths in the United States, according to Nora Volkow, Director of the National Institute on Drug Abuse, part of the National Institutes of Health. She spoke with NIH Director Francis Collins in a recent web conversation.

AMA urges states to act to maintain access to care for patients with pain or OUD. The American Medical Association is urging governors and state legislatures to take action to ensure that patients being treated with opioids, whether for chronic pain or as medication-assisted treatment for substance use disorder, maintain access to their therapies during the coronavirus pandemic.

Physicians who treat patients with chronic pain may need to work even harder to keep their patients safe during the COVID-19 pandemic, according to experts at Quest Diagnostics. The same is true for those with patients with substance use disorder (SUD) or mental health conditions. Medication overuse or excess alcohol consumption is a risk, and medication adherence may be a challenge that physicians must face squarely during these trying times.

Decreased baseline health and access to behavioral healthcare for Blacks and Latinos increase their risk for worsening mental health during the COVID-19 pandemic, according to a statement from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The American Society of Regional Anesthesia and Pain Medicine (ASRA) and European Society of Regional Anesthesia and Pain Therapy (ESRA) have issued a joint statement on recommendations for chronic pain practice during the COVID-19 pandemic.

Recommendations for further actions to treat and protect patients with opioid use disorder during the COVID-19 pandemic. According to an Ideas and Opinions article published in the Annals of Internal Medicine (2 April 2020), the government needs to do more to help patients with opioid use disorder (OUD) to weather the COVID-19 pandemic.

New options for Specimen Collection from Quest Diagnostics Drug Monitoring. Clinical Drug Monitoring is a critical tool to measure and assess prescription compliance and help identify drug misuse. With the ongoing COVID-19 pandemic and social distancing, many patients are not getting to their physicians’ offices for the drug monitoring testing they need.

Drug Mixing: The Most Prevalent, and Dangerous, Form of Drug Misuse. Is your patient mixing prescribed medications with non-prescribed or illicit drugs? Most clinicians underestimate the likelihood that their patients are engaging in this most-prevalent type of prescription drug misuse. But what they don’t know could hurt their patients.

Treating mental health and substance use disorder patients during the COVID-19 pandemic. Patients who are suffering from a substance use disorder and/or mental health condition are likely to be greatly impacted by the societal changes due to the COVID-19 pandemic. Social distancing may be our best hope to slow the spread of this novel disease.

Screening for substance use in all pregnant women is recommended by both the American College of Obstetrics and Gynecology (ACOG) and the American Society of Addiction Medicine (ASAM) in order to provide women and their fetuses and children with the best care during and after pregnancy.

Women with untreated substance use disorder during pregnancy have multiple and interacting risks that impact both maternal and fetal health. Understanding the complex issues in this group of patients is important for delivering the best care.

Despite More Prescriptions, Naloxone is Still Dramatically Underprescribed. When given promptly, naloxone can reverse an opioid overdose and save a life. But despite an increase in prescriptions since 2012, and despite being recommended as a risk mitigation strategy in the CDC Guideline for Prescribing Opioids for Chronic Pain, naloxone is still highly underprescribed, according to a new study from the Centers for Disease Control and Prevention.

Medication-based treatment with methadone, buprenorphine, or extended-release naltrexone is effective for opioid use disorder (OUD), saving lives and improving long-term outcomes even in the absence of other forms of treatment, according to a major new review from the National Academies of Sciences, Engineering, and Medicine. The study was led by Alan Leshner, Emeritus CEO of the American Association for the Advancement of Science, the publisher of the journal Science.

New HHS guide on reducing or discontinuing Opioids: individualize, and go slow. The Department of Health and Human Services has released a decision-making guide for physicians who are considering reducing or discontinuing opioid treatment for their patients.

Medication-assisted treatment (MAT) for opioid use disorder (OUD) has emerged as a key strategy for combatting the opioid epidemic. Controlled research has shown it to be more effective than abstinence programs in treating patients with the disorder (Connery, 2015).

Drug Misuse in America 2019: Physician Perspectives and Diagnostic Insights on the Evolving Drug Crisis, a Quest Diagnostics Health Trends™ report, presents findings from analysis of more than 4.4 million de-identified aggregated clinical drug monitoring tests performed by Quest Diagnostics for patients from all 50 states and District of Columbia from 2011 through 2018.

New Case Study now available: When considering Opioid therapy—the importance of baseline drug testing for amphetamines and methamphetamines. When following CDC guidelines and ordering baseline drug testing prior to initiating opioid therapy, it can be challenging to identify potential amphetamine and methamphetamine misuse. This case study illustrates some steps that could be appropriate to take to better understand your patient’s potential use or misuse of these two drugs.

Attitudes, and the Language that Reflects Them, Take Their Toll on Patients

In-depth interviews with patients with substance use disorder reveal the toll taken by stigma on patients’ experience in the healthcare system, according to a new study. The study included 48 individuals across Ontario, Canada, who were taking opioids for chronic pain (n=28) or other reasons (n=31)."

For Pregnant Women, Early Screening and Medication-Assisted Therapy Provide the Best Outcomes for Opioid Use Disorder, for Both Mothers and Infants. Pregnant women should be screened for opioid use disorder (OUD) and receive medication- assisted therapy (MAT) instead of withdrawal, according to recommendations from the American College of Obstetrics and Gynecology (ACOG). The Committee Opinion was published in August, 2017 in collaboration with the American Society of Addiction Medicine.

Do you know the signs of opioid use disorder? The Centers for Disease Control and Prevention offers a Continuing Medical Education Module on this topic, as part of its effort to reduce the harms from use of opioids and other drugs. 

Payers Have an Important Role to Play in Reducing Opioid Harm. Health insurance companies can play a central role in limiting the harm of opioids, according to a 2017 white paper by the Healthcare Fraud Prevention Partnership (HFPP). In “Healthcare Payer Strategies to Reduce the Harms of Opioids,” the HFPP encourages appropriate care and prescribing practices for patients; identifying and eliminating fraud, waste, and abuse within the healthcare system; and supporting dissemination of information about effective opioid misuse strategies.

Pill shaving refers to the practice of scraping or crushing part of a pill to dissolve it in a urine sample. What can you do to rule out pill shaving?

How the Words We Use Can Create, or Avoid, Stigma for the Person with Substance Use Disorder. “Language matters,” says Shawn Ryan, MD, chief medical officer at BrightView Health in Cincinnati, Ohio. “We know that patients can suffer under the stigma of inappropriate language” when referring to their use of opioids and other drugs.

Reducing stigma is a key part of fighting the opioid crisis, according to Patrice Harris, MD, President of the American Medical Association and Chair of the AMA’s Opioid Task Force. “We must all confront the intangible and often devastating effects of stigma,” she said.

Heightened awareness of the dangers of prescription opioids has prompted a movement to limit use of opioid therapies for patients with acute or chronic pain. Primary care practitioners stand on the front lines of this care shift, and many are curtailing prescribing opioids in response.

The US Food and Drug Administration has updated its recommendationson co-prescribing benzodiazepines with medication-assisted therapy treatment, stating that buprenorphine and methadone “should not be withheld from patients taking benzodiazepines or other drugs that depress the central nervous system.”

How Well are Physicians Complying with CDC Opioid Prescribing Recommendations? A report by the insurance industry group AHIP (America’s Health Insurance Plans) suggests that physicians still have a way to go to be in compliance with the 2016 opioid prescribing and monitoring recommendations from the Centers for Disease Control and Prevention. 

Presumptive drug testing can give you rapid results that can be used to help improve patient care. But whether a presumptive test is right for your patient depends on many factors, according to Dr. Leland McClure, Director, Medical Science Liaison, Medical Affairs at Quest Diagnostics, and understanding the complexities of presumptive testing is vital for making the right testing choice. Dr. McClure outlined these complexities in a recent webinar.

Labor force participation among men of prime working age is lowest in areas where prescription opioid use is highest, according to a 2017 analysis by Alan Krueger, PhD, of Princeton University and the National Bureau of Economic Research.

Access to medication-assisted treatment will increase under the new opioid bill. In October 2018, the president signed the SUPPORT for Patients and Communities Act,which addresses multiple aspects of the opioid crisis. Several provisions in the bill are slated to increase access to medication-assisted treatment (MAT), in which buprenorphine or another medication is part of the treatment plan for substance use disorder.

Led by Synthetic Opioids, Drug Overdose Deaths Climbed Through 2017. Have They Reached a Plateau? Data released by the Centers for Disease Control and Prevention indicate that deaths due to drug overdoses climbed from 2015 through the end of 2017, but preliminary data suggest the annual death rate may have reached a plateau.

As a Prescriber, What is Your Role in Preventing Prescription Drug Diversion?Diversion of prescription medications is a major part of the epidemic of substance abuse in the United States. Clinicians who prescribe opioids and other controlled substances have an important role to play in preventing drug diversion, through maintaining good records and secure prescription pads, communicating with patients and other prescribers, and monitoring compliance with urine drug testing.

In late September 2018, the US House and Senate agreed on a compromise bill to address multiple aspects of the opioid crisis.

How does oxycodone differ from hydrocodone? How powerful is fentanyl compared to morphine? A working knowledge of opioids is important for clinicians who treat patients with chronic pain.

Where are the hotspots for drug misuse in America? And what are the trends in your state? Quest Diagnostics has produced an interactive map that provides state-by-state information that can guide your thinking on problems in your area.

For patients with chronic pain, opioid medications can offer an important treatment option. If you are a clinician who is new to prescribing opioids, there are several important resources and best practices that can help keep your patients safe and properly treated while receiving opioids.

The Council of Economic Advisors says that the cost of the nation’s opioid epidemic in 2015 was $504 billion, or 2.8% of that year’s Gross Domestic Product. “This estimate dwarfs estimates from previous studies,” the Council states in its February 2018 CEA Annual Report.

The number of approved providers of buprenorphine per opioid overdose death is lower than average in 11 states in the Midwest and Mid-Atlantic, according to an analysis by the health policy consulting group Avalere.

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 for patients in all 50 states and D.C. between 2011 and 2017.

Visit us at Booth 311 and get a sneak peek at our Health Trends™: Drug Misuse in America 2018 report.

Chronic pain affects tens of millions of people in the United States, and according to the Centers for Disease Control, in 2016, prescribers wrote 66.5 opioid and 25.2 sedative prescriptions for every 100 Americans.

Quest Diagnostics is pleased to sponsor the August 13-14, 2018 Opioid Management Congress in Nashville, TN. Use promo code: QUEST for an early registration discount, and join us for our lunch presentation on August 13, 2018.

Every state now has a prescription drug monitoring program (PDMP) in place to record prescriptions of controlled substances, but they vary widely in the information they collect and whether and how physicians must consult the database.

More than a quarter of patients being tested for either prescribed opioids or prescribed benzodiazepines tested positive for both drugs, according to a new study in the Journal of Addiction Medicine.

The quantity of opioids prescribed in the United States peaked in 2010 and has been falling since, according to a new study from the Centers for Disease Control and Prevention (CDC). But the quantity prescribed in 2015, the last year for which comprehensive data are available, is still more than three times as high as it was in 1999.

It is clear that the prescription opioid epidemic is a nationwide problem, but for now, one of the most important weapons against it is being wielded inconsistently from state to state. Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases of prescribing and dispensing information from healthcare providers and pharmacies.

The Federation of State Medical Boards (FSMB) recommends that urine drug testing be used as part of a comprehensive management strategy for patients receiving prescription opioids for chronic pain.

Opioids and other medications (non-opioid analgesics, benzodiazepines, antidepressants, anticonvulsants, muscle relaxants) are prescribed to treat chronic pain of non-cancer origin. Ongoing monitoring of these patients is important to ensure safe and effective therapy.

For patients with chronic pain, opioids may offer important relief from suffering and help support activities of daily living. At the same time, if they are not used according to your prescription, opioids can do great harm.

Physicians must take into account many factors when making decisions about opioid prescriptions, including the risk that the individual patient may divert prescription medications for illegal use. To aid physician decision-making, the state of Maine in 2013 instituted its Diversion Alert program, a program that gives physicians access to state records of arrests or summons for prescription or illegal drug-related crimes. Physicians can view data from the previous 11 months, and can receive monthly updates.

In 2016, the Centers for Disease Control published an updated guideline for primary care clinicians who are prescribing opioids for chronic pain (outside of active cancer treatment, palliative care, and end-of-life care). It’s an extensive study, with a thorough review of the evidence. But the main message is contained in 12 key points, summarized here.