Quest Diagnostics - Prescription Drug Misuse - Report On Marijuana and Prescription Drugs - 2013
Quest Diagnostics - Prescription Drug Misuse - Report On Marijuana and Prescription Drugs - 2013
Quest Diagnostics - Prescription Drug Misuse - Report On Marijuana and Prescription Drugs - 2013
Prescription Drug Misuse is Prevalent 6 Marijuana: The Most Misused Drug 8 Recreational Marijuana Users More Likely to Misuse Other Drugs 9
Summary
Despite relaxed public attitudes and new decriminalization laws in several states (Figure 1), a large body of evidence chronicles the adverse health impacts of marijuana. The drug, derived from the leaves, stems and other parts of the hemp plant Cannabis sativa, contains delta-9-tetrahydrocannabinol, or THC, a psychoactive chemical which affects areas of the brain associated with pleasure, memory, thinking and coordinated movement. Evidence suggests that smoking marijuana raises certain health risks, particularly on neurological functioning. These risks seem to be most pronounced for the developing adolescent brain. Marijuana is also associated with cardiovascular and mental health risks in adults. In addition, marijuana smoke contains known carcinogens, although links to lung cancer have not been well substantiated.1 Marijuana use is associated with other forms of drug abuse. While some research questions if the link between marijuana and other drug abuse is causal,2 other studies find that marijuana use typically precedes the use of potentially more dangerous drugs, such as cocaine and heroin. A recent study published in the Journal of Adolescent Health found that men and women who had used marijuana were 2.5 times more likely to later misuse prescription drugs compared to those who abstained. 3 FIGURE 1. LEGAL STATUS OF MARIJUANA USE BY STATE
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Regardless of these risks, marijuana is the most widely used illicit drug in the world. 4 The use of marijuana in the United States is increasing. In 2010, more than 29 million Americans (11.5%) age 12 or older reported using marijuana within the past yeara significant increase over rates reported each year from 2002-2008, according to the National Institute on Drug Abuse. 5 Other research suggests a decrease in perceived risk of marijuana use in young adolescents corresponds with increased risk of marijuana use (Figure 2). 6 In recent years, new legislation permitting the use of marijuana for medicinal purposes or recreation has gained ground at the state level. Eighteen states and the District of Columbia now permit marijuana use for medicinal purposes. In November 2012, a majority of voters in Colorado and Washington voted to legalize adult social use of marijuana. Despite increasing efforts to legalize marijuana, the Obama Administration has stated its opposition to any form of drug legalization.7 FIGURE 2. MARIJUANA USE AMONG 12TH GRADERS* VS. PERCEIVED RISK
2008
25.8% 32.4%
2010
24.5% 34.8%
2012
Source: University of Michigan Institute for Social Research and NIDA, 2012
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Our analysis included results of testing services ordered by physicians, such as family practitioners and internists, serving patients in a primary care setting. We also included results of specialists that may be expected to use our prescription drug monitoring services, including psychiatrists and neurologists, and for patients under care at pain management clinics and hospitals. We did not include results of patients tested by drug rehabilitation clinics, given the unusually high rates of drug inconsistency expected within this clinical segment, or from clinicians, such as addiction specialists, focused on drug addiction. The companys Quest Diagnostics Health Trends studies are performed in compliance with applicable privacy regulations, the companys strict privacy policies and as approved by the Western Institutional Review Board. Our findings include: P rescription drug misuse continues to be highly prevalent. About 60% of patients failed to use their prescription drugs as indicated by their ordering physician in 2012, compared to 63% in 2011. Despite increased public attention on the epidemic of prescription drug abuse in recent years, our data suggests prescription drug misuse continues to be a healthcare concern for a significant percentage of patients prescribed opioids, sedatives, stimulants and other medications. M arijuana was the most misused drug. Non-prescribed marijuana was detected in more than one in four patients (26%) with inconsistent test results. These findings confirm other research that demonstrates that marijuana is the most commonly abused illicit drug in the United States. 3 R ecreational marijuana users were more likely than non-users to misuse other drugs. Nearly half (45%) of patients who used marijuana recreationally also used other non-prescribed drugsmost commonly sedatives and narcotic pain killerscompared to approximately one third (36%) of non-marijuana users. These findings build on prior research correlating recreational marijuana use with other forms of drug abuse. In addition, prescribed marijuana users were not significantly more likely to inappropriately use other drugs. R ecreational marijuana users were not more likely than non-users to divert or skip medications. Based on test results, recreational marijuana users were as likely as non-users to not use their prescription medications. A patient may not take a prescribed drug due to financial constraints and diversion, including illegal drug sales.
Prescription drug misuse can include selling or giving away medications, combining drugs without a clinicians oversight and skipping medications.
60% Di erent Drugs Found (25%) Additional Drugs Found (33%) No Drugs Found (42%)
40% Consistent
60% Inconsistent
In 2012, among patients with inconsistent results, 33% tested positive for the prescribed drug(s) and at least one other additional drug, compared to 32% in 2011. Twenty-five percent tested positive for a drug, but not the one for which they were prescribed, compared to 28% in 2011. A large number of patients also showed no drug, including medications specified by the ordering physician, was detected by lab testing in both years: about 42% showed no drugs reported in 2012, compared to 40% in 2011. Financial constraints limiting the ability to buy medications, as well as illegal sales of prescription drugs (diversion), may largely explain this pattern. Opioid medications continued to comprise the overwhelming majority of medications prescribed (69% in 2012 and 71% in 2011). Opioids include codeine, hydrocodone, hydromorphone, morphine, oxycodone and oxymorphone. Given the high rates of misuse, these findings suggest a substantial number of Americans taking medications, including powerful and potentially addictive opioids, may be putting their health at risk.
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We also found high patterns of misuse in women and men of all ages and health plan categories in both years (Table 1). In light of our findings, healthcare providers and policy makers may consider taking additional measures to educate patients in the dangers of prescription drug misuse and monitor for medication compliance. TABLE 1. PRESCRIPTION DRUG MISUSE IN AMERICA
Study Features
Number of de-identified urine results Overall inconsistency rate Among inconsistent results, percentage tested positive for the prescribed drug(s) and at least one other additional drug Among inconsistent results, percentage tested positive for a drug, but not the one for which they were prescribed Inconsistent results in which no drug specified by the ordering physician was detected
2012
151,405
2011
75,997
Commentary
60%
63%
33%
32%
25%
28%
42%
40%
Many patients do not take their medications perhaps due to financial restraints or through illegal sale of medications Men and women abuse prescription drugs equally Every age group is at risk A slight decrease in inconsistency rates was observed in each Health Plan category
Inconsistency rate by gender Inconsistency rate across age groups Inconsistency by Health Plan category
Source: Quest Diagnostics, 2011 - 2012
In both years, most age groups had rates of misuse of 50% or higher 70% Medicaid 58% Medicare 59% Private Payer 72% Medicaid 61% Medicare 62% Private Payer
14% 8% 6%
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45% 36% Marijuana Not Prescribed Marijuana Positive Marijuana Not Prescribed Marijuana Negative 37%
Marijuana Prescribed
Marijuana Positive
Among recreational marijuana users, the most frequently detected additional non-prescribed drugs were sedative medications, such as alprazolam and oxazepam (a tranquilizer that is also a metabolite of benzodiazepine drugs such as diazepam and chlordiazepoxide), and narcotic pain killers, such as hydromorphone, a metabolite of hydrocodone and also a prescribed drug (Figure 6). Based on this analysis, patients who use marijuana recreationally are 1.3 times more likely to use other non-prescribed drugs, including sedatives and narcotic pain killers, than non-marijuana users. Clinicians may wish to more closely counsel and monitor patients suspected of recreational marijuana use in order to help minimize other forms of drug abuse. FIGURE 6. MOST FREQUENTLY DETECTED NON-PRESCRIBED DRUG CLASSES AMONG RECREATIONAL MARIJUANA USERS
30% 25%
25%
20%
20%
15% 10% 5% 0%
19%
17%
Oxazepam
Temazepam
Hydromorphone
Alphahydroxyalprazolam
Based on our test data, recreational marijuana users were only slightly more likely than non-users not to use their prescription drugs. A patient may not take a prescribed drug due to financial constraints and diversion, including illegal drug sales. As many as 7.9% of patients who tested positive for non-prescribed marijuana were negative for their prescribed medications, as compared to 7.4% for non-prescribed marijuana users.
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Research Methodology
Study Objectives The objectives of our study were to assess and identify the most frequently detected non-prescribed drugs and identify patterns of misuse among inconsistent patient samples. We assessed: Inconsistency rates across a range of demographics T he patterns of misuse, including: (1) use of non-prescribed illicit or prescription drugs in combination with a prescribed medication; (2) the use of additional, non-prescribed (illicit or controlled) drugs; and (3) the failure to use prescribed drugs T he patterns of misuse as a function of non-prescribed marijuana use and use of prescription cannabinoid drugs
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References
1. esearch Report Series: Marijuana Abuse. National Institute on Drug Abuse, U.S. Department R of Health and Human Services, September 2010.
2. V on Grundy K, Rebellon CJ. A life-course perspective on the gateway hypothesis. Journal of Health and Social Behavior. Sept. 2010:51:244-59. 3. F iellin L, Tetrault J, Becker W, Fiellin D, Hoff R. Previous use of alcohol, cigarettes, and marijuana and subsequent abuse of prescription opioids in young adults. Journal of Adolescent Health, August 2012. 4. UNODC, World Drug Report 2010. United Nations Publication, Sales No. E.10.XI.13. 5. T opics in Brief: Marijuana. National Institute on Drug Abuse, U.S. Department of Health and Human Services, December 2011. 6. Monitoring the Future, National Results on Drug Use, The University of Michigan Institute for Social Research, 2012. 7. M edical Marijuana State Laws. National Conference of State Legislatures website www.ncsl.org, January 2013. 8. I s Marijuana Medicine? Drug Facts. National Institute on Drug Abuse, U.S. Department of Health and Human Services, July 2012. 9. T he DEA Position on Marijuana Use, U.S. Department of Justice, Drug Enforcement Administration, January 2011.
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