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Better guidelines could help reduce racial disparities in clinical drug testing, physicians say

Sixty-nine percent of physicians report needing more tools to be able to address racial/ethnic disparities in prescription drug management, according to the 2021 Quest Health Trends® Report, the latest in a series of reports designed to bring objective data to the understanding of the nation’s healthcare challenges. This year’s report combines analysis of nearly 5 million deidentified test results from Quest Diagnostics with results from a Harris Poll survey of over 500 physicians, conducted in August 2021. 

Recent research has shown that physicians are more likely to discontinue long-term opioid therapy (LTOT) in patients testing positive for an illicit drug when the patient is Black than when the patient is White. Gaither et al reviewed electronic medical records from Veterans Administration patients between 2000 and 2010, to determine the rate at which LTOT was discontinued within 60 days of a urine drug test positive for an illicit drug. Among 15,366 LTOT patients, about equally divided between Black and White patients, Black patients were more likely to undergo urine drug testing within 60 days of treatment commencement (25.5% of Black patients versus 15.8% of White patients, p<0.001). Black patients were 2.1 times as likely than White patients to have LTOT discontinued if they tested positive for cannabis, and 3.3 times more likely if they tested positive for cocaine.

Physicians surveyed in the Health Trends® Report overwhelmingly agreed (88%) that better guidelines would help to ensure that clinical drug testing is used equitably.

The report was authored by Jay G. Wohlgemuth, MD, senior vice president, R&D and Medical, and chief medical officer for Quest Diagnostics; Harvey W. Kaufman, MD, senior medical director and director, Health Trends Research Program for Quest Diagnostics; and Creighton Drury, chief executive officer, Partnership to End Addiction.

Source:  Wohlgemuth JG, Kaufman HW, Drury C. Health Trends Drug Misuse in America 2021: Physician perspectives and diagnostic insights on the drug crisis and COVID-19. 

Gaither JR, Gordon K, Crystal S, et al. Racial disparities in discontinuation of long-term opioid therapy following illicit drug use among black and white patients. Drug Alcohol Depend. 2018;192:371-376.