Database Review Shows Age Not a Barrier to Opioid Use and Misuse

May 17, 2012

Review of 725,000 prescription drug monitoring samples demonstrate older patient population — particularly “Boomers” — are at risk for Rx misuse, abuse and drug interactions

BALTIMORE, Md. – May 17 – AmeritoxSM, the nation’s leader in pain medication monitoring, announced today the presentation of a scientific poster titled “Patterns of Drug Use in the Older Chronic Pain Population” at the American Pain Society Annual Meeting.  Ameritox researchers will share analysis from 725,679 urine drug monitoring samples from chronic pain patients aged 50 and older.  Data show almost one-third (31.8 percent) lacked the physician-prescribed pain medication in clinically sampled urine, and more than a quarter (28 percent) of patients’ samples contained a prescription drug not prescribed by the doctor ordering the monitoring test.

Although the common perception is that America’s prescription drug misuse concerns should focus on the young, data suggest that older pain patients have the same issues with potential non-adherence and medication misuse as the overall chronic-pain population. The Ameritox study suggests health professionals should put aside age as a predictive indicator in evaluating medication adherence. The study concludes that there is a significant potential for non-adherence in the older population.

“This study provides strong evidence that there are two major reasons to monitor medication use, using urine drug testing, in older patients with chronic pain. The first is that this population has a risk of medication misuse and illicit drug use that warrants attention,” said Dr. Harry Leider, Chief Medical Officer of Ameritox. “The second is that a powerful medication was found in one in four older patients — one that the doctor prescribing a pain medication was not aware of. This data provides a compelling rationale for routinely monitoring medication use in older patients on chronic opioids.”

An additional factor that drives a portion of medication misuse in older patients is the use of multiple medications, prescribed by different physicians, for multiple chronic conditions.  This places the older population at a higher risk for dangerous drug-drug interactions. In addition, older patients may not remember or keep track of all of their medications prescribed by various physicians. Common side effects and interactions that can occur as a result include: constipation, mental status changes, depression and falls. Drug monitoring can help provide physicians with a more complete picture of a patient’s medication use prior to a serious event occurring.

The “Patterns of Drug Use in the Older Chronic Pain Population” poster was co-authored by Lisa Burke, PhD, MBA, RN, and Monica Fay, PharmD, MBA, Associate Director Medical  Affairs at Ameritox, who examined extensive data of urine drug monitoring results taken from patient samples of those 50 years and older and submitted for analysis to Ameritox from October 1, 2009 to September 30, 2011; a total of 725,679 samples.  Results of this testing revealed:

  • 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.

These data are similar to findings of a 2009 study[i] of more than 900,000 samples taken from individuals across age groups.  Therefore, presenters suggest that “age may not be a predominate factor in the likelihood of misuse or abuse of drugs.”   Frequently, older patients are perceived as more adherent to their physicians’ prescribed drug regimen.  These large-scale urine drug test studies show that monitoring could aid significantly in helping physicians[ii] identify clinical inconsistencies and should augment patient self-reporting[iii].

The American Pain Society and American Academy of Pain Medicine guidelines for chronic opioid therapy state that “clinicians should consider periodically obtaining urine drug screens or other information” as part of their plan of care.

“Older adults are the fastest growing subset of theU.S.population and one of the largest groups of chronic pain patients,” said Lisa Burke, PhD, MBA, RN, Ameritox.  “With physicians on the front lines of patient care, pain medication monitoring, through urine drug testing, is an important tool to help clinicians ensure their patients – regardless of their age – receive the best possible care.”

The U.S. Department of Health and Human Services Administration on Aging reports the older population — persons 65 years or older — numbered 39.6 million in 2009 (the latest year for which data are available). This age group then represented only 12.9% of theU.S.population, approximately one in every eight Americans. By 2030, there will be about 72.1 million older persons, more than twice their number in 2000.

About Ameritox
Ameritox is the nation’s leader in Pain Medication Monitoring Solutions®, offering specialized laboratory testing and reporting services. Ameritox’s expertise and innovative science provide physicians with insights and support to enhance and optimize the care of chronic pain patients. Ameritox offers the most thorough pain medication monitoring lab process – Rx GuardianSMwith Rx Guardian CD, the only pain medication monitoring process with a proprietary normalization algorithm and a reference database of pain patients clinically assessed for medication adherence. Patient results are compared against this database, helping physicians assess whether patients are taking their pain medications correctly. Monitoring through prescription drug testing helps physicians make more informed clinical decisions and manage the risks and complexities associated with prescribing pain medications. Ameritox is headquartered in Baltimore, Md. with laboratory facilities in Midland, Texas and Greensboro, N.C. Ameritox can be found online at www.ameritox.com, on Twitter@Ameritox, or on Facebook at facebook.com/ameritox.

© 2011 Ameritox Ltd. All rights reserved. AMERITOX, the AMERITOX logos, AMERITOX AUTOREMINDER, AMERITOX MEDICATION MONITORING SOLUTIONS, AMERITOX UNIVERSITY, PAIN MEDICATION MONITORING SOLUTIONS, POWERED BY YOUR NEED TO KNOW and PROTECT YOUR PATIENTS. PROTECT YOUR PRACTICE. RX GUARDIAN, RX GUARDIAN CD, and RX GUARDIAN AUTOREMINDER are trademarks of Ameritox.



[i] Couto, JE, Romney, MC, Leider, H.L., et al. (2009). High rates of inappropriate drug use in the chronic pain population.  Population Health Management[i]

[ii] Katz NP, et al. Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesth Analg. 2003;97(4):1097–102.

[iii] Atluri S, Sudarshan G. Evaluation of abnormal urine drug screens among patients with chronic non-malignant pain treated with opioids. Pain Physician. 2003;6:407–9.