A majority of doctors say theywish they had more training on what to do if a patient shows signsof addiction. (Photo: Getty)

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There's still a lot of work to do to bring the nation's opioid crisis under control, but the healthcare industry needs to wake up and realize it's only a matter oftime before the same thing happens with a new drug.Over-prescribing other drugs could result in a new crisis, which iswhy prescription drug monitoring and additional training about thechallenges of addiction is so critical fordoctors.

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So say 500 doctors responding to a Quest Diagnostic survey,augmented by information from 4.4 million of the firm's clinicaldrug monitoring tests, the findings of both detailed in the report,"Drug Misuse in America 2019: Physician Perspectivesand Diagnostic Insights on the Evolving Drug Crisis."

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Related: Meet benzodiazepines, America's next big drugproblem

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"Many physicians are struggling to treat chronic pain, caughtbetween a justified reluctance to prescribe opioids and areasonable worry that the opioid epidemic will give way to misuseof other prescription or illicit drugs," the authors write."However, while they focus on responsible use of traditionallymisused medications, misuse of other drugs is on the rise."

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Indeed, 62 percent of the doctors surveyed fear the opioidcrisis will just be traded for another prescription drug crisis,substantiated by a review of Quest Diagnostics patient tests, whichfound that 51 percent of test results show signs of misuse.

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"Given the current levels of misuse, more efforts are needed toensure patients are taking medications as prescribed," the authorswrite. "While physicians are confident in their ability to discussthe risks of prescription drug misuse with patients, only 55percent said they actually discussed potential misuse with most oftheir patients who were prescribed controlled substances in thepast month. Even more alarming, more than half (56 percent) believethere is no way of knowing if patients take their controlledsubstances as prescribed."

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Complicating this are potential problems arising from drugmixing, according to the report. While 24 percent of patient testresults showed misuse of controlled substances by combiningprescription medications with other drugs–including illicit drugs,other prescriptions, or alcohol – over half (53 percent) of thedoctors surveyed underestimate drug mixing, believing that lessthan 20 patient of patient test results showed misuse of substancesin this way.

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"To combat prescription drug misuse, the healthcare communityand policy-makers have the opportunity to develop resources andtools to confront prescription drug misuse and protect patientsfrom substance use disorders," the authors write. "A majority ofphysicians recognize a need for more education about addiction —from what to do if a patient shows signs of a substance usedisorder, to how to taper patients off opioids."

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The majority (70 percent) of doctors surveyed say they wish theyhad more training on how to taper their patients off opioids, and75 percent say they wish they had more training on what to do if apatient shows signs of addiction.

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"One tool physicians believe is useful in preventing andidentifying prescription drug misuse is prescription drugmonitoring; however, they also express challenges in using it inpractice," the authors write. "Prescription drug monitoring isclinical testing (commonly via urine testing) to identify the drugsin a patient's system, including controlled prescriptionmedications and illicit drugs."

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A third (33 percent) worry they will offend their patients ifthey recommend prescription drug monitoring, while half 50 percentwho do not always use prescription drug monitoring say access andcost issues (i.e., concerns around insurance coverage, feeling itis too expensive, or finding it inconvenient for patients) preventthem from using prescription drug monitoring more often.

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Still, 88 percent say prescription drug monitoring is criticalto help identify patients who may be misusing prescription drugs,and 92 percent believe prescription drug monitoring willincreasingly become the standard of care when prescribingcontrolled substances. Virtually all (95 percent) say it'simportant to use prescription drug monitoring while a patient isprescribed a controlled substance, and 90 percent say it'simportant to use prescription drug monitoring as a baseline priorto prescribing a controlled substance.

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The Center on Addiction, which co-sponsored the physiciansurvey, writes that more education is necessary to help healthcareprofessionals challenge the stigma and stereotypes long associatedwith addiction.

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"Stigma can prevent people from seeking treatment and affect ahealthcare professional's willingness to assess or treat dependenceor substance use disorder," the nonprofit writes. "The time is nowto end the stigma: one in two people know someone affected by theopioid epidemic — and only about 20 percent of those with opioidaddiction get the treatment they need."

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Katie Kuehner-Hebert

Katie Kuehner-Hebert is a freelance writer based in Running Springs, Calif. She has more than three decades of journalism experience, with particular expertise in employee benefits and other human resource topics.