M

any Americans appear to be misusing their prescription drugs in ways that put their health at risk, notably combining dangerous combinations of medicines, according to a report released this week.

The rate at which drugs were misused was 54 percent last year, according to the new analysis of more than 3.1 million de-identified laboratory test results. This was down from 63 percent in 2011, although the findings were quite similar to what was found in 2013 and 2014, according to Quest Diagnostics, the laboratory testing company, which conducted the analysis.

The analysis combed through test results for inconsistencies, such as a patients taking medicines with other drugs for which they don’t have prescriptions, or if they were skipping doses.

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Of the tests indicating misuse, about 45 percent showed evidence that patients mixed medicines, which the lab company interpreted as a sign that a “sizable” number of patients might be using dangerous drug combinations.

Notably, this finding was much higher than in previous years — there was evidence that drugs were inappropriately mixed in 32 percent of the 2011 lab tests and 35 percent of the 2014 tests. Quest said the most recent results are significant because combinations of certain drugs — notably, opioids, and sedatives — can cause dangerous interactions, such as severe respiratory depression, coma, and death.

“The discovery that a growing percentage of people are combining drugs without their physician’s knowledge is deeply troubling, given the dangers,” said F. Leland McClure III, Quest’s medical affairs director, in a statement. “Perhaps patients do not understand that mixing even small doses of certain drugs is hazardous, or they mistakenly believe prescription medications are somehow safe.”

On the bright side, test results for children between the ages of 10 and 17 showed rates of inconsistent prescription drug use of 44 percent last year, a sharp drop from 70 percent in 2011. There was also a decline among children younger than 10 years old, falling to 31 last year from 34 percent in 2014. Quest speculated this may reflect greater oversight by parents or guardians.

Here are some other interesting findings:

Among the youngest patients — those younger than 10 — amphetamines were associated with the most inconsistent results, followed by benzodiazepines and methylphenidate, which is the generic name for Ritalin. Quest rightfully noted that these stimulants are frequently prescribed to treat children who are diagnosed with attention deficit hyperactivity disorder.

Among those 25 and older, benzodiazepines had the highest number of inconsistent test results, while in patients 18 and up, opiates generated the second-largest number of inconsistent results. “The misuse of opioids is especially troubling due to risk of harm or potentially fatal overdose that is associated with concurrent use of benzodiazepine drugs and other central nervous system depressants,” Quest wrote.

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The percentage of test results showing inconsistent medicine use — and absolutely no trace of any prescription drug — fell to 32 percent last year from 40 percent in 2011. Why might this happen? Well, a patient may not take a prescribed drug as directed or simply stop due to side effects, a belief their affliction has ended, or a lack of funds. Quest also posited that some folks sell their meds for money.

Meanwhile, patients with hepatitis C tested positively for additional, nonprescribed drugs more frequently than people who did not have the chronic virus — 66 percent compared with 51 percent. And hepatitis C patients also showed evidence of using painkillers that were not prescribed, as well as heroin, at a far higher rate than those without the disease.

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  • Hard to believe quest would put their name on an article this outdated. Sad commentary about editorial understanding of our interest in patient reality.

  • Some of these psych meds are deliberately combined in an effort to find new ways to get high. Add to that the street drugs, rave drugs, X, rufies, etc. Why? To quote a song the pills that mommy gives you don’t do anything at all. 20% of incoming college frosh are on psych meds, and when I look at my old school somebody could make a good living selling tee shirts with the song title “I want a new drug” (Huey Lewis).

  • The other potential issue is likely a bit more nuanced – “a growing percentage of people are combining drugs without their physician’s knowledge.” What is the likelihood that the naive consumer has Doctors who have tunnel-vision or don’t communicate with each other?

    • I think that lack of communication is more likely. Two serious drawbacks to communication at work. Many doctors, even with full disclosure are ignorant of drug interactions. We are also dealing with the unintended consequences of HIPAA, which requires that the patient give permission for their medical records to be disclosed, even to other physicians. Finally we can’t ignore the mindset of the many people who believe that if one pill is good two must be better.

    • Interesting that Quest found all these drug levels. If one of these patients wound up in the emergency room comatose after an overdose they would more likely be discovered after their stomach got hosed with a gavage tube, their bladder got catheterized for a urine drug sample and they were tasting activated charcoal for the next two days.

    • These data show lots of HepC can’t stay off the smack, which got them into trouble in the first place, and proves that states were correct in requiring clean drug screens for six months before approving Sovaldi and Harvoni.

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