Two major reasons to monitor medication use in older patients with chronic pain

Ameritox (SM), the nation's leader in pain medication monitoring, announced today the presentation of a peer-reviewed 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 medical directors 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 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 identify clinical inconsistencies and should augment patient self-reporting. 

The American Pain Society and American Academy of Pain Medicine clinical recommendations support pain medication monitoring as a tool to help confirm whether patients adhere to their prescribed drug regimen.

"Older adults are the fastest growing subset of the U.S. population and one of the largest groups of chronic pain patients," said Lisa Burke, PhD, MBA, RN, Ameritox.  "With physicians increasingly on the front lines of patient care and public safety, 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 and achieve relief from chronic pain."

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 the U.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.