Identifying unprescribed controlled medication use: a database analysis

Abstract

Hospitalizations and deaths due to unintentional poisonings have been on the rise over the last decade, primarily due to prescription opioids, sedatives and tranquilizers. The largest increases in numbers of cases and percentage of hospitalizations from 1999-2006 were due to benzodiazepines and methadone, respectively, emphasizing the need to closely monitor patients who are taking these medications.1 Urine drug monitoring is an important tool which provides the clinician with additional information to optimally manage patients requiring treatment with controlled substances. Urine samples tested by Ameritox between the dates of October 1, 2009 and October 1, 2010 were evaluated (using proprietary methodology) to assess the likelihood that patients with chronic pain were taking their medications as prescribed. Overall, there were 922,440 samples tested during this period. Of these, a preliminary analysis was conducted on 2% of the samples (n=17,970) to determine the most common prescription drugs that were present but not recorded on the requisition form. The most common medication categories tested for and detected included benzodiazepines, opiates, opioids and amphetamines. Specifically, oxazepam, alprazolam, diazepam, hydrocodone, oxycodone and morphine were most commonly found. Potential reasons for these findings include clerical errors in the patient chart or on the requisition form, patient confusion about their medications, multiple prescribing physicians, hoarding of older prescription medications for PRN use, or abuse of unprescribed medications. Given the dramatic rise in abuse and misuse of prescription medication, these data emphasize the need for routine urine drug monitoring in patients with chronic pain to determine the likelihood of adherence to prescribed medications, as well as to provide evidence of any additional medications the patient may be ingesting, whether intentional or unintentional. (1. Coben J, American Journal of Preventative Medicine, 2010).