Health Trends™: Drug Misuse in America 2018—Diagnostic Insights from Clinical Drug Monitoring into the Opioid Epidemic

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 on patients in all 50 states and the District of Columbia between 2011 and 2017. To our knowledge, this report is the largest of its kind to provide current insights into prescription and illicit drug use and misuse in the United States based on laboratory insights.

In this report, we reveal evolving patterns in drug misuse, specifically:

  • The rate of drug misuse remained constant, as it has for several years. The misuse rate in 2017 was 52 percent, unchanged from 2016. This suggests improvements in appropriate drug use have plateaued, and a majority of patients tested continue to present evidence of potential drug misuse.
  • Despite the unchanged rate, the nature of the drug misuse epidemic is shifting. Among patients in general care, rates of misuse of several commonly prescribed opioids and other drugs, as well as certain illicit drugs, declined over the past year. However, rates of misuse of certain drugs, including heroin and non-prescribed fentanyl, skyrocketed among individuals most at risk – those in addiction treatment centers.
  • Drug mixing, a contributing factor to overdose deaths, is the most frequent form of misuse observed in the Quest data, and it shows no signs of abating. The highly dangerous combination of opioids and benzodiazepines is frequently found in patients tested in primary care and pain management settings.
  • Gabapentin has emerged as a potential concern, with dramatic increases observed in misuse in just one year.

For clinicians, drug monitoring can provide insights into possible forms of misuse including: substance use disorders, dangerous drug combinations, incomplete treatment, and/or “diversion” – instances where the prescribed drug is not found in the patient’s sample, suggesting the patient is possibly filling the prescription but may be diverting the drug to others or opted not to take it.

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