Patients Not Monitored for Prescription Drug Abuse Effectively

According to a study performed by researchers at the Albert Einstein College of Medicine of Yeshiva University, a vast majority of primary care physicians are not monitoring patients using prescription opioid drugs, which carry a high risk of abuse, addiction and overdose.

“Our study highlights a missed opportunity for identifying and reducing misuse of prescribed opioids in primary care settings,” said lead author Joanna Starrels, M.D., M.S., assistant professor of medicine at Einstein.

The study was published in the Journal of General Internal Medicine. It found that not only were doctors lax about monitoring patients on addictive painkillers, but they did not change their behavior when it came to monitoring patients who were at higher risk for developing an opioid addiction, such as patients with a history of drug or substance abuse.

For about two years, the researchers studied the medical records of over 1,600 patients under primary care who received regular prescriptions of opioids, all of whom received the drugs for chronic pain unrelated to cancer. The researchers observed how much the patients were monitored during this time and to what degree, such as the use of urine drug testing and face-to-face meetings. Researchers also observed whether the patients received multiple early drug refills and whether this was ever noted by their physician.

It was reported that only 8 percent of patients underwent urine drug tests; only 24 percent of the high-risk patients who had a history of drug or substance misuse underwent a urine test. 50 percent of the patients were seen on a regular basis in the office, with no increase percentage for high-risk abuse patients.

“We were disturbed to find that patients with a drug use disorder were seen less frequently in the office and were prescribed more early refills than patients without these disorders,” said Dr. Starrels. This finding, she says, should “be a call for a standardized approach to monitoring.”

Only 23 percent of the patients studied received early opioid refills, but the high risk patients more frequently received multiple early refills.

In 2004, the National Institute on Drug Abuse (NIDA) reported that approximately 48 million over the age of 12 were estimated to have taken prescription drugs for non-medicinal purposes in their lifetimes. This figure represents about 20 percent of the United States population.

Among unlawfully used drugs, prescription drug abuse is ranked second on the national scale, right behind marijuana. According to NIDA, over 2.2 million Americans were reported as to having used pain killers for non-medical reasons for the first time in 2009.

Starrels and her co-authors made the recommendation that physicians implement some risk-reduction strategies, such as standardizing a plan of action for all patients who will be on opioids for an extended period of time (which would include urine drug testing), scheduling regular face-to-face meetings to evaluate the patients’ response to the drugs and evidence of misuse, and sticking to an agreed-upon refill schedule.

“Most primary care physicians are attuned to these problems,” said Dr. Starrels, “but they haven’t put sufficient strategies in place to help reduce risks.”