Helping you stay current in drug monitoring




Marijuana, opioids, and amphetamines rank high in safety-sensitive workforce drug test results

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…

Dec 28, 2020

A randomized, placebo-controlled, double-blind demonstration of kratom’s potential as an analgesic

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…

Nov 30, 2020

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…

Nov 03, 2020

Prescribing During the Pandemic: Keeping Your Patients Safe

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 .…

Oct 21, 2020

Director of the National Institute on Drug Abuse: COVID-19 may be contributing to a resurgence in drug-related deaths

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.

After a long…

Oct 07, 2020

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. Among their recommendations, they urge officials to:

    Sep 21, 2020

COVID-19 and Substance Use Disorder: Getting Your Patients Back to Care

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…

Sep 08, 2020

Combatting racial and ethnic behavioral health disparities during the pandemic

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 coronavirus (COVID-19) pandemic has revealed deep-seated inequities in health care for…

Aug 26, 2020

Professional societies issue joint recommendations on chronic pain management during pandemic

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 include:

  • Substituting telemedicine visits for in-person visits where possible.
  • For patients infected…

Aug 18, 2020

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. William Becker, MD, and David Fiellen, MD, both of the Yale Program in Addiction…

Jul 08, 2020

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. It is imperative to keep this essential diagnostic…

Jun 29, 2020

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.

According to the 2019 Quest Diagnostics Health Trends Report, 24% of patient…

May 06, 2020

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. Dr Francis Collins, Director of the…

Mar 25, 2020

Drug Testing in Pregnancy

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. In a 2017 joint…

Mar 18, 2020

Trends and Treatment of Opioid Use During 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. Recent studies and position papers outline the scope of the issue, and provide guidelines…

Mar 05, 2020

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…

Dec 17, 2019

Medication-based Treatment for Opioid Use Disorder: Effective even alone, but vastly underutilized

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…

Dec 04, 2019

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. The 5-page booklet discusses:

  • The situations in which opioid tapering or discontinuation may be appropriate
  • The risks of rapid opioid tapering
  • Steps…

Nov 21, 2019

Medication-assisted treatment for opiod use disorder (OUD)

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). The ability of physicians and other healthcare professionals to use MAT…

Oct 29, 2019

Health Trends™ Drug Misuse in America 2019: Physician Perspectives and Diagnostic Insights on the Evolving Drug Crisis now available!

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…

Oct 18, 2019

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.

Oct 11, 2019

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). The authors identified 3…

Aug 06, 2019

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.…

Jul 30, 2019

What are the Signs of Opioid Use Disorder? What Every Healthcare Provider Should Watch For

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. You can get started by going to

Jul 15, 2019

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…

Jun 26, 2019

The Importance of Definitive Drug Testing: Pill Shaving Case Study

The results from Dylan’s drug test are back, and they show presence of an opioid-consistent with the oxycodone you’ve prescribed him. No problem, right?


Detecting the parent drug won’t rule out the possibility that Dylan is “pill shaving” to pass the test, while diverting the…

Jun 11, 2019

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. By changing that language, Dr. Ryan says, healthcare practitioners can deliver more compassionate…

May 28, 2019

AMA President Highlights Reduction in Stigma to Help End Opioid Crisis

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. “The key to…

May 21, 2019

Benzodiazepines: Primary Care’s New Drug Problem

Dr. Jeff Gudin reflects on the impact of Benzodiazepines:

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…

Apr 30, 2019

Don’t Withhold Medication-assisted Therapy from Benzodiazepine Users, FDA says

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.” While the combination of benzodiazepines or other CNS depressants with…

Apr 03, 2019

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. And when it comes to…

Mar 18, 2019

Presumptive Drug Testing: Rapid Results for Your Patient

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…

Mar 06, 2019

Opioid use and lower rates of work go hand-in-hand

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.

The participation rate for men ages 25 to 54, which…

Feb 22, 2019

Come see us at the 3rd Opioid Management Summit

Quest Diagnostics ​is proud to be an executive partner of the 3rd Opioid Management Summit February 26-27, 2019 in Washington, DC.

Join us on February 26 at 10:30 AM as we present: Patterns of Drug Misuse in America and Reducing Risks…

Feb 12, 2019

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…

Jan 31, 2019

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.

According to the data, total drug overdose deaths were approximately…

Jan 17, 2019

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,…

Jan 08, 2019

House and Senate Prepare to Pass a Bipartisan Bill to Fight the Opioid Crisis

In late September 2018, the US House and Senate agreed on a compromise bill to address multiple aspects of the opioid crisis. Among the key provisions in the bill are ones to:

· Enhance access to non-opioid pain treatment options provided by Medicaid.

· Improve data sharing for…

Dec 20, 2018

Know your opioids

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. Opioids include:

Morphine, derived from secretions of the poppy plant. The strength of other opioids is usually given as “morphine equivalents,” based…

Dec 17, 2018

Quest Diagnostic’s Health Trends Map Provides state-level Information on Drug Use and Misuse in America

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.

The map details state-level data on test results that are…

Nov 29, 2018

New to Prescribing Opioids? What You Need to Know to Keep Your Patients Safe

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.

Centers for Disease Control Guideline…

Oct 26, 2018

Opioid epidemic’s 1-year cost: $504 Billion

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 Council is an…

Oct 16, 2018

Buprenorphine provider gap in Midwest and Mid-Atlantic

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. Buprenorphine is used to treat opiate use disorder, and may be prescribed by nurse practitioners and…

Sep 20, 2018

2018 Quest Diagnostics Health Trends™ report now available

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. To our knowledge, this report is the largest…

Sep 07, 2018

Attending PAINWeek® in Las Vegas?

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

Health Trends™: Drug Misuse in America 2018, a Quest Diagnostics report, presents findings from analysis of more than 3.9 million de-identified aggregated clinical drug monitoring tests performed by Quest Diagnostics…

Aug 24, 2018

How can Prescription Drug Monitoring help identify abuse?

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. “These are sobering statistics,” says F. Leland McClure, PhD, MSci., F-ABFT, director,…

Aug 24, 2018

Come see us at the Opioid Management Congress - August 13-14, 2018

​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:

Clinical Drug Monitoring & Analytics as an Objective…

Jun 28, 2018

Can mandatory consultation of a state PDMP reduce overdose morbidity? Maybe.

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. Beginning in 2013, New York instituted mandatory consultation for physicians: before they prescribe an…

Nov 15, 2017

Opioids and Benzodiazepines: A Dangerous, and Common, Combination

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.

“Our findings far exceed previous estimates of combining opiates and benzodiazepines based on prescribing databases alone, suggesting existing prescription…

Nov 13, 2017

Number of Opioids Prescribed Has Fallen Since 2010

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…

Nov 10, 2017

States Vary Widely in What They Collect, from Whom, and When, for their PDMPs

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.…

Sep 05, 2017

Updated Guidelines from the Federation of State Medical Boards on Prescribing and Testing for Opioids

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.

“Periodic and unannounced drug testing (including chromatography) are useful in monitoring adherence to the treatment plan, as well as in…

Aug 14, 2017

The Role of Urine Drug Testing in Pain Management

by Amanda J. Jenkins, Ph.D.

Scientific Director, Toxicology

Opioids and other medications (non-opioid analgesics, benzodiazepines, antidepressants, anticonvulsants, muscle relaxants) are prescribed to treat chronic pain of non-cancer origin.1

Ongoing monitoring of these patients is important to ensure safe and effective therapy. Drug testing is one tool utilized to identify…

Jul 14, 2017

What a PDM Program Can Offer Your Practice

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. A prescription drug monitoring (PDM) program can help you maintain the maximum benefit…

Jul 12, 2017

Maine’s Diversion Alert Program Aids Physician Decision-Making

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…

Jul 05, 2017

Do You Know the CDC Guidelines for Prescribing Opioids and Monitoring Their Use?

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…

Jul 05, 2017