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

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

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

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

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

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

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

The majority (70 percent) of doctors surveyed say they wish they had more training on how to taper their patients off opioids, and 75 percent say they wish they had more training on what to do if a patient shows signs of addiction.

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

A third (33 percent) worry they will offend their patients if they recommend prescription drug monitoring, while half 50 percent who do not always use prescription drug monitoring say access and cost issues (i.e., concerns around insurance coverage, feeling it is too expensive, or finding it inconvenient for patients) prevent them from using prescription drug monitoring more often.

Still, 88 percent say prescription drug monitoring is critical to help identify patients who may be misusing prescription drugs, and 92 percent believe prescription drug monitoring will increasingly become the standard of care when prescribing controlled substances. Virtually all (95 percent) say it's important to use prescription drug monitoring while a patient is prescribed a controlled substance, and 90 percent say it's important to use prescription drug monitoring as a baseline prior to prescribing a controlled substance.

The Center on Addiction, which co-sponsored the physician survey, writes that more education is necessary to help healthcare professionals challenge the stigma and stereotypes long associated with addiction.

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

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Prescription drug misuse: It's not just opioids

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