Monday, May 21, 2012

Age and Opioid Misuse: Probably Not What You Think

Ameritox announced last week the release of a peer-reviewed poster at the annual meeting of the American Pain Society that draws some surprising conclusions about age and opioid misuse.  Turns out being older doesn't necessarily make you more responsible. 
The study is based on over 700,000 urine drug monitoring samples from chronic pain patients over the age of 50.  Notable results:

  • 7.6% had an illicit drug detected (e.g., marijuana, cocaine metabolite, heroin metabolite or PCP)
  • 28.1% had a non-prescribed drug detected (e.g., opiates, benzodiazepines, barbiturates, etc.)
  • 31.8% did not have a prescribed drug detected (e.g., a prescribed pain medication)
  • 45.9% of samples had no abnormality found.

  • Wow.  54% of the samples had some inconsistency detected. 

    I've learned from past experience (and from conversations with Dr. Leider, Chief Medical Officer for Ameritox) that one cannot jump to conclusions based on UDM testing alone.  Grandpa isn't necessarily selling his Oxycontin just because it didn't show up in his drug screen. 

    But this study does suggest that equal vigilance is required by the medical community (physicians, payors, caregivers, etc.) in monitoring opioid use among older patients as with younger patients.  It would be entirely inappropriate for a physician to forego regular, random drug screening for a chronic pain patient on opioid therapy just because the patient appears old enough to have grandkids. 

    It's also important to note that even a perfectly implemented drug monitoring program can't fix these issues by itself.  A strong UDM program should prompt conversations between prescribers and patients to ensure that the right therapy is being delivered safely and effectively to accomplish the established treatment goals.  If nefarious behavior is uncovered, providers need to act judiciously to ensure the patient has an opportunity to get help if needed. 

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