In August of 2018, the National Institute on Drug Abuse (NIDA) published a report on overdose death rates. At that time, although the count for 2017 was not finalized, NIDA estimated over 72,000 people within the US died of drug overdose. That is a rate of 197 deaths per day or 8 per hour. Approximately 29,406 of those deaths involved a synthetic opioid (primarily Fentanyl) overdose. 15,958 of these deaths directly involved Heroin. The number of deaths involving Cocaine was approximately 14,556. While all of us are familiar with the dangers of the aforementioned drugs, there are still approximately 12,000 of the 72,000 deaths remaining. Care to venture a guess as to what drugs are involved with the remaining 12,000 deaths?
Y’all (do you like that bit of Nashville, TN?) are just too smart. Benzodiazepine is the correct answer. Most providers I know do not write prescriptions for Heroin, Fentanyl or Cocaine. The over the top fear of the Opioid Epidemic (a subject for another time) has many providers decreasing their script writing for opioids and increasing the amount of scripts for anti-anxiety medications in an attempt to assist their patients. Drugs such as Xanax (Alprazolam), Ativan(Lorazepam), Klonopin(7-Aminoclonazepam) and Valium(Diazepam) are being prescribed for patients with pain. It is my deeply held believe that most providers have their patients’ best interest in mind and do all they are able to for their patients, within the restrictive environment our government has created. My purpose of this blog is not to debate the appropriateness or efficacy of any providers scripting practices. I do, however, write these to help educate you in order for you to test your patients appropriately.
Based solely on the above statistics it is easy to understand after an initial baseline test for all patients, why providers test medium to high risk patients for the opioids, illicits and Benzodiazepines at a minimum. I have not even discussed the abuse of amphetamines, muscle relaxants and anti-convulsants such as Gabapentin that we see in the lab. Under testing patients is a result of fear mongering by insurances. I am not advocating over testing, however I am encouraging appropriate testing and providers making a diagnostic or therapeutic decision for their patient based on the results reported. Do you really think insurance companies read the statistics in the first paragraph and give a hoot? After thirty years in the health care business I am here to tell you they do not!! I will never tell a provider how to practice medicine or tell them what to test, however it is the labs job to assist and educate any provider who requests such help. We are here to do that. Wow, almost went off on the insurance companies!
Thank you for your business.
Lance Benedict
President/CEO Industry Lab Diagnostic Partners
02/08/2019