Quest PrescriptionDrugPainTrendsReport W15

1 Summary About Drug Monitoring Tests and Drug Misuse Finding 1: More than half of patients misuse their medications Finding 2: Misuse of most prescription and illicit drugs declined, but is still prevalent, in general care patients Health Trends . Finding 3: Drug mixing, a contributing factor to overdose deaths, is the most frequent form of misuse observed in the Quest data, and it shows Drug Misuse in America 2018. no signs of abating Finding 4: Gabapentin misuse is on the rise PDMPs and Pain Diagnostic Insights from Clinical Drug Monitoring Methodology into the Opioid Epidemic About Health Trends . References For more information about Quest Diagnostics, visit September 2018. Health Trends . Drug Misuse in America 2018. Summary We are pleased to present this year's Quest Diagnostics Health Trends report on Drug Misuse in America. About Drug Monitoring The statistics the Centers for Disease Control and Prevention (CDC) provide about the drug epidemic are bleak. Tests and Drug Misuse Drug overdoses killed more than 72,000 Americans in 2017, a 13 percent increase over the previous year and a two- fold increase over the past decade.

2 The sharpest increase occurred among deaths related to fentanyl and fentanyl Finding 1: More than analogs (synthetic opioids) with nearly 30,000 overdose half of patients misuse their medications Behind these data is devastation. Drug misuse takes lives, destroys families and affects the fabric of communities. For these reasons, we believe the drug epidemic is one of the most significant and challenging healthcare issues of Finding 2: Misuse of our time. most prescription and illicit drugs declined, but In this report , we provide insights into the evolving drug misuse epidemic insights based on analysis of clinician - is still prevalent, in general ordered drug monitoring performed for patients across the United States by Quest Diagnostics. care patients Laboratory data is foundational to healthcare. As you will see in this report , it can reveal trends and patterns that prescription, claims and other data cannot, both for the individual and populations. With these insights, patients, Finding 3: Drug mixing, healthcare providers and policy makers are empowered to take actions leading to better health.

3 A contributing factor to overdose deaths, is the We hope the present report informs your understanding of the evolving drug epidemic and its impact on the lives of most frequent form of patients, families and the community at large. misuse observed in the Quest data, and it shows no signs of abating Regards, Finding 4: Gabapentin misuse is on the rise PDMPs and Pain Methodology Jay G. Wohlgemuth, Harvey W. Kaufman, Senior Vice President, R&D Senior Medical Director and Director About Health Trends and Medical, and Chief Medical Officer Health Trends Research Program References 2 For more information about Quest Diagnostics, visit Health Trends . Drug Misuse in America 2018. Summary Summary About Drug Monitoring Drug Misuse in America 2018, a Quest Diagnostics Health Trends report , presents findings from analysis of more Tests and Drug Misuse than million de-identified aggregated clinical drug monitoring tests performed by Quest Diagnostics for patients in all 50 states and between 2011 and 2017.

4 To our knowledge, this report is the largest of its kind to provide Finding 1: More than current insights into prescription and illicit drug use and misuse in the United States based on laboratory insights. half of patients misuse their medications In this report , we reveal evolving patterns in drug misuse, specifically: Finding 2: Misuse of The rate of drug misuse remained constant, Drug mixing, a contributing factor to overdose most prescription and as it has for several years. The misuse rate in deaths, is the most frequent form of misuse illicit drugs declined, but 2017 was 52 percent, unchanged from 2016. observed in the Quest data, and it shows is still prevalent, in general This suggests improvements in appropriate no signs of abating. The highly dangerous care patients drug use have plateaued and misuse rates combination of opioids and benzodiazepines remain at high levels. is frequently found in patients tested in Finding 3: Drug mixing, primary care and pain management settings.

5 A contributing factor to overdose deaths, is the Despite the unchanged rate, the nature of the Gabapentin has emerged as a potential most frequent form of drug misuse epidemic is shifting. Misuse of concern, with dramatic increases in misuse misuse observed in the some drugs shows signs of decline in certain observed in just one year. Quest data, and it shows populations, but explosive growth in others. no signs of abating Non-prescribed fentanyl and heroin are particular threats. Finding 4: Gabapentin misuse is on the rise for clinicians , drug monitoring can provide insights into possible forms of misuse including: substance use PDMPs and Pain disorders, dangerous drug combinations, incomplete treatment, and/or diversion instances where the prescribed drug is not found in the patient's specimen, suggesting the patient is possibly filling the prescription Methodology but may be diverting the drug to others or opted not to take it. About Health Trends The intent of this and other Quest Diagnostics Health Trends reports is to provide insights based on objective laboratory data.

6 Please refer to the Methodology on page 16 for a detailed explanation of our study method and References strengths and limitations. 3 For more information about Quest Diagnostics, visit Health Trends . Drug Misuse in America 2018. Summary About Drug Monitoring Tests and Drug Misuse Why would a About Drug Monitoring prescribed drug Tests and Drug Misuse Laboratory test results provide objective information that can assist healthcare providers to assess patients' use of prescribed medications, not be found? Finding 1: More than other controlled non-prescribed drugs and illicit drugs. half of patients misuse Patients may not take their medications In the case of clinical drug monitoring, a healthcare provider orders drug their prescribed drugs testing and indicates the drug or drugs prescribed for the patient. Quest due to concerns of side Finding 2: Misuse of Diagnostics categorizes test results as consistent or inconsistent based effects, because their most prescription and on the presence of drugs or drug metabolites identified through laboratory pain or other symptoms illicit drugs declined, but testing and their alignment with the prescription information provided by the have subsided, or to hoard is still prevalent, in general healthcare provider.

7 For future pain relief. care patients Some patients A consistent result indicates that the prescribed drug or drugs found match may not take Finding 3: Drug mixing, those the healthcare provider indicated were prescribed for the patient on their prescribed a contributing factor to the test order. drugs because they overdose deaths, is the An inconsistent result suggesting possible misuse occurs when: cannot afford them. most frequent form of misuse observed in the Some patients sell or give Quest data, and it shows Additional drugs are found: their drugs to others not no signs of abating all prescribed drugs are detected, but at least one other drug, authorized to use them. non-prescribed or illicit, is also detected. Finding 4: Gabapentin A small number of misuse is on the rise patients may be rapid Different drugs are found: metabolizers of the PDMPs and Pain at least one prescribed drug is not detected, and at least prescribed drug and the one other drug, non-prescribed or illicit, is detected.

8 Drug or metabolite is Methodology undetectable at the time No drugs are found: of testing. About Health Trends . at least one prescribed drug was not detected, and non-prescribed or illicit drug(s) were also not detected. References 4 For more information about Quest Diagnostics, visit Health Trends . Drug Misuse in America 2018. Summary A non-prescribed drug refers to a prescription drug which was not prescribed for the patient as indicated by About Drug Monitoring the healthcare provider on the test order. Tests and Drug Misuse Inconsistent results can reflect potential problems for Finding 1: More than the patient and the healthcare system: half of patients misuse their medications Drug combining, whether involving prescription or illicit drugs, can lead to dangerous drug interactions. Finding 2: Misuse of most prescription and Test results that show evidence of a non-prescribed illicit drugs declined, but drug likely indicate the patient is using the drug is still prevalent, in general without the benefit of a physician's oversight.

9 Care patients Failure to take a prescribed drug may contribute to healthcare waste, ineffective treatment and the Finding 3: Drug mixing, potential for unintentional or criminal diversion. a contributing factor to overdose deaths, is the For more information about Quest Diagnostics most frequent form of Drug Monitoring for clinicians , visit misuse observed in the Quest data, and it shows no signs of abating Finding 4: Gabapentin misuse is on the rise PDMPs and Pain Methodology About Health Trends . References 5 For more information about Quest Diagnostics, visit Health Trends . Drug Misuse in America 2018. Summary Finding 1: More than About Drug Monitoring half of patients misuse Tests and Drug Misuse their medications Inconsistency Trends Finding 1: More than half of patients misuse In 2017, 52 percent of drug monitoring tests performed 100%. their medications by Quest showed signs of potential misuse, the same percentage as in 2016. In fact, the rate of prescription 90%.

10 Finding 2: Misuse of misuse has been relatively constant for the past most prescription and five years, following a dramatic decline in the rate 80%. illicit drugs declined, but of inconsistent test results from 63 percent in 2011, is still prevalent, in general Quest 's first full year of drug monitoring, to 53 percent 70%. care patients in 2014. 63%. 60%. 60%. Finding 3: Drug mixing, This suggests improvements in appropriate drug use 55% 53% 54%. a contributing factor to have plateaued and misuse rates remain at high levels. 52% 52%. overdose deaths, is the 50%. most frequent form of Among the 52 percent of specimens that showed misuse observed in the evidence of inconsistent results in 2017: 40%. Quest data, and it shows Forty-five percent were positive for non-prescribed no signs of abating 30%. or illicit drugs in addition to all their prescribed drugs, Finding 4: Gabapentin compared to 43 percent in 2016. 20%. misuse is on the rise Thirty-four percent did not show all the drugs they had been prescribed, or any other tested drug, the same 10%.