A new Quest Diagnostics report released on September 6, 2017 reveals that over 50% of drug test results showed evidence of misuse of prescription drugs.  The report, entitled “Prescription Drug Misuse in America: Diagnostic Insights in the Growing Drug Epidemic,” examined 3.4 million prescription medication monitored lab tests performed by Quest between 2011 and 2016.  The report found that the rate of inconsistency in 2016 was 52% (Quest categorized test results as “consistent” or “inconsistent” based on the presence of drug metabolites identified through laboratory testing and their alignment with the information provided by the healthcare provider on the test order). Inconsistent results are potential indicators that patients are misusing one or more drugs.  Quest also reported that 22% of all specimens tested showed non-prescribed or illicit drugs in addition to the patient’s prescribed drugs, reflecting the potential for dangerous drug combinations.

Additionally, the Quest Diagnostics report found that, amongst the specimens tested, more than 20% were positive for both opioids and benzodiazepines (a class of psychoactive drugs often used to treat conditions such as anxiety and depression), more than 10% were positive for both opioid and alcohol and 3% percent were positive for all three. Among all specimens positive for heroin, 19% were also positive for non-prescribed fentanyl.  In addition, 12% of all specimens positive for prescribed opioids were also positive for prescribed benzodiazepines, suggesting one or more healthcare providers had prescribed these drugs for the patient.  While co-prescribing may be medically appropriate for a limited number of patients, these drug combinations greatly increase the risk for potentially lethal respiratory depression.

While there was an 11% decline in prescription inconsistency ratings from 2011, misuse remains high – suggesting that employers are likely to encounter misuse of prescription medications in the workplace.

As we have discussed in previous blog posts, employers should consider whether they are equipped to respond to this epidemic:

• Review workplace policies and practices to address the use of prescription medications that may cause a safety risk in the workplace. Employees in “safety-sensitive” jobs should report the use of prescription medications that may impact the ability to perform the job safely, so that the Company can address the matter with the employee.
• Review substance abuse policies to prohibit the use of prescription medications for which the employee does not have a valid prescription.
• Where permitted by applicable law, consider expanding drug testing panels to cover prescription medications as well as illegal drugs. All positive drug tests should be reviewed by a Medical Review Officer, who will determine whether the drug use was lawful or unlawful.
• Educate employees on the dangers of using opioid pain medications, and publish options for employees to seek help for substance abuse problems, such as an Employee Assistance Program.
• Train supervisors on addressing suspected misuse of drugs and alcohol in the workplace. Distinguish between employees who violate Company policies by using drugs at work, and employees who volunteer that they have a substance abuse problem before a policy violation has occurred.
• Train supervisors on the legal issues involved when discussing an employee’s medical condition, disability status and related use of prescription medications, which can lead to disability discrimination claims if handled improperly.