Over the course of my career in clinical toxicology, I unfortunately have witnessed countless preventable drug overdose deaths. Nationally, the most recent data from the CDC reports 72,000 drug overdose deaths estimated in 2017. In California, public health officials estimated more than 5,000 residents died from fatal drug overdoses last year. We are losing people at a rate that is unacceptable on a national level and in California.
The nature of prescription drug misuse does not discriminate based on ethnicity, social or economic background, or state lines. Here in California, the trends emerging are particularly concerning. With more and more patient lab test results indicating concurrent use of opioids and benzodiazepines — a potentially lethal combination — the threat of drug overdose is incredibly high.
As a subject matter expert for Quest Diagnostics, it is my job to analyze trends in deidentified patient test results, including drug monitoring. The anonymous nature of these data sets puts a degree of separation between the human impact and the population data being reviewed. However, the reality on the ground is devastating.
I too have had friends, relatives, and neighbors pulled into misuse, which includes substance use disorders and other dangerous behaviors, such as drug combining. Drug misuse can and does happen to anyone.
Addressing California’s opioid and prescription drug problem requires a comprehensive and aggressive approach. I commend California on its work to date. In 2016, the state passed Senate Bill (SB) 482, which requires doctors to consult the Controlled Substance Utilization Review and Evaluation System (CURES), which tracks a patient’s prescription history; as of October 2018, consulting CURES is mandated. While California has had some success with this program, and it certainly does save lives, there is more that can be done to combat misuse.
Prescription drug misuse may include supplementing, substituting, or abstaining from taking prescription medications as prescribed. Many of the individuals most at risk are those who may not have been prescribed a drug before, do not yet have a substance use disorder but have other risk factors, or who practice dangerous forms of drug misuse that cannot be flagged through the CURES database. Physicians may believe that they can tell if a patient will misuse a prescribed therapy, however, without definitive evidence to flag when a patient may be at risk or misusing, this assumption can prove deadly.
Insights from a Quest Diagnostics 2018 analysis of more than 3.9 million de-identified aggregated drug monitoring tests reveal a shocking truth: more than half of patients who take prescription opioids, amphetamines, and other therapies show signs of misuse when tested. Use of illicit drugs, such as heroin, is also a growing national problem, as individuals denied access to opioid drugs turn to other means.
California’s state leaders can make it easier for healthcare providers to keep patients safe by enforcing policies that mirror the Centers for Disease Control and Prevention (CDC) 2016 Guidelines for Prescribing Opioids for Chronic Pain, supporting provider-patient interaction through investing in provider and patient education, and requiring payers to cover objective assessments that identify prescribed medications, other controlled prescription drugs, and illicit substances before they can become deadly.
For many Californians, pain is a very real, daily challenge, and healthcare providers must be allowed to consider opioids for relief when other measures won’t do. If providers do not have access to all viable means to protect their patients, it is all but certain that prescription drug misuse — and drug overdose deaths — will continue.
Jack Kain, PharmD, Director, Medical Science Liaison, Prescription Drug Monitoring & Toxicology, for Quest Diagnostics, the world’s leading provider of diagnostics information services, including clinical drug monitoring.