More than 40 percent of North Carolina patients whose urine was sampled after they received prescriptions for strong pain medications lacked evidence of the drugs in their bodies, according to a new report from a national drug testing lab.
The failure to take prescribed pain drugs leaves open the possibility that addictive medicines such as Oxycontin and Vicodin are being misused, shared or sold to others, said Kathryn Bronstein, vice president for medical affairs at Ameritox, which conducted the study from information gathered in 2012.
“Of course, there may be a legitimate reason – maybe they were in an awful lot of pain and ran out a couple of days before the test, or maybe they weren’t liking the side effects,” Bronstein said. “But it does give their physician a reason to think: This is a person I need to talk to about their prescription.
“We have to be really careful that being treated for chronic pain doesn’t become a source of potential diversion.”
Patients who are prescribed opioids and other addictive pain medications are tested periodically to assure that the medications are being taken as directed. Ameritox is among a number of companies that conduct such tests.
The company’s report was based on the results of 527,000 urine tests taken from patients from across the country, including 25,000 in North Carolina.
State tops national stat
Nationally, 36 percent of pain patients were found not to be taking the drug they had been prescribed, while that figure was 43.6 percent for North Carolina, one of the 10 highest rates in the country. Other states with high numbers included Michigan and Georgia, with 45.8 percent, and South Carolina, with 45.7 percent.
Results of the survey also showed that in North Carolina 31.5 percent of patients were taking another, non-prescribed drug and that 9.8 percent were found to be using illegal drugs.
Mike Lancaster, of Community Care of N.C., said the numbers reported by Ameritox – a Maryland-based drug testing company with labs in Greensboro and Midland, Texas – are higher than he would expect. Lancaster said more and more physicians are adopting drug screenings for pain patients as they try to reign in instances of abuse and overdose.
ODs on the rise in state
Deaths from prescription drug overdoses – also known as unintentional poisonings – are rising faster in North Carolina than in the rest of the nation. Overdose rates increased by more than 300 percent between 1999 and 2011, the most recent figures available.
The N.C. Department of Health and Human Services reported 297 overdose deaths in 1999 and 1,140 in 2011. Health officials say most of the deaths involved opioid pain medications such as oxycodone, methadone and hydrocodone.
Community Care of N.C. has a $2.6 million grant to address overdose issues in North Carolina. Known as Project Lazarus, the effort promotes safer practices surrounding how drugs are prescribed by doctors, dispensed by pharmacies and stored by consumers.
“We’re doing about 40 trainings around the state, and we talk about the need to see that people are indeed taking the medication you are giving them,” he said.
Lancaster said he recommends in-office tests that offer quick results so physicians can talk with patients immediately about any issues uncovered in a urine test, such as the presence of non-prescribed drugs that may cause complications when taken with pain medications.
“If you tell me you are in extreme pain but don’t have opiates in your system, I’m going to have some questions,” he said.
Tessie Castillo, communications coordinator for the N.C. Harm Reduction Coalition, urges caution with the use of drug testing.
She said a 2013 study published in the Public Library of Science concludes that preventing pain patients from receiving adequate medication could cause them to seek out illegal drugs, such as heroin.
“Other concerns are patient privacy issues, especially if law enforcement is involved, and fear that the system might wrongly flag people with chronic pain,” Castillo said.
The N.C. Harm Reduction Coalition seeks more options for people who have become addicted to prescription medication while suffering from chronic severe pain, she said.
The coalition backed successful bills in the N.C. legislature this year giving some immunity to Good Samaritans seeking medical help for overdose victims and providing easier access to the opiate antidote naloxone.