Majority of Physicians Worry Signs of Addiction Were Missed During Pandemic, Finds New Quest Diagnostics Health Trends® Report
First-of-its-kind study reveals nearly three in four physicians believe telehealth visits limit the ability to determine if patients are at risk for or are already misusing prescription drugs
Four in five physicians say a lack of drug testing during the pandemic put more people at risk for undetected drug misuse or use disorders
76% expect deaths from drug overdose will continue to rise even as the pandemic subsides

SECAUCUS, N.J., Nov. 15, 2021 /PRNewswire/ -- A new Health Trends® report from Quest Diagnostics (NYSE: DGX) finds that almost 70% of physicians fear they missed signs of drug misuse during the pandemic, and, given how the global health crisis disrupted medical care, anticipate rising overdose deaths – especially those involving prescribed and non-prescribed (illicit) fentanyl – even as the pandemic subsides.

By combining an analysis of nearly 5 million de-identified aggregated Quest Diagnostics test results, including over 475,000 from 2020 alone, with a survey from the Harris Poll of more than 500 primary care physicians, "Drug Misuse in America 2021: Physician Perspectives and Diagnostic Insights on the Drug Crisis and COVID-19," provides a unique snapshot of prescription and illicit drug misuse in the United States during the COVID-19 pandemic. The Partnership to End Addiction was an advisor to the report's development.*

The new report comes on the heels of the approximately 96,779 drug overdose deaths between March 2020 and March 2021, as reported by the Centers for Disease Control and Prevention (CDC).i It also builds on prior Health Trends research, including a 2019 report that examined physician attitudes on drug misuse and a 2020 report that showed positivity increased by 35% for non-prescribed fentanyl and 44% for heroin among tested individuals during the early months of the pandemic.ii

To access the 2021 Health Trends report, visit Quest Diagnostics Newsroom - Health Trends®.

"Today, America faces a triple threat to our collective health as the COVID-19 pandemic continues, mental health issues increase and drug misuse skyrockets," said report co-author Harvey W. Kaufman, M.D., Senior Medical Director and Director, Health Trends Research Program for Quest Diagnostics. "Quest undertook this Health Trends research to provide insights into physician's perspectives on the impact of the pandemic on the drug crisis and their confidence in their ability to manage patients amid the risks. We discovered that physicians on the front lines are worried about their patients prescribed controlled medications and need comprehensive resources and education to identify and combat drug misuse."

Among the key findings:

Physicians fear they didn't spot signs of addiction amid the pandemic:

  • 67% of physicians worry that they have missed signs of drug misuse and use disorders (indicating addiction) among one or more of their patients during the pandemic.
  • 94% of primary care physicians report seeing more patients experiencing stress, anxiety or other mental health issues because of the pandemic and fear a correlation between rising mental health issues and prescription drug misuse.
  • Moreover, 98% of physicians say they are concerned about misuse of controlled substances in general compared to 75% saying the same for opioids.

Telehealth hinders the ability of physicians to recognize danger signs:

  • While many practices substituted or expanded telehealth for in-person care during the pandemic, 75% of physicians believe telehealth visits limit the ability to determine if patients are at risk for or are already misusing prescription drugs.
  • 91% of physicians feel confident they can recognize the signs of prescription drug misuse during in-office interactions with patients, but only 50% report the same confidence via telehealth visits.

Physicians are concerned patients will turn to illicit fentanyl given the lack of treatment options for chronic pain combined with reduced opioid prescribing; Gabapentin leads as medication of choice for chronic pain:

  • 87% of physicians said they prescribed gabapentin for chronic pain in the past 6 months, far more than the two-thirds who prescribed opioids (65%), likely reflecting concerns about potential opioid misuse.
  • Indeed, 78% of physicians fear patients will turn to illicit fentanyl if they cannot get a prescription medication and 86% worry that illicit fentanyl will claim more lives than prescribed opioids.
  • Quest Diagnostics laboratory data shows positivity for non-prescribed fentanyl increased by 35% during the pandemic (from 4.3% to 5.8%) in tested patients.

Despite physician confidence in counseling patients, nearly half of tested patients show drug misuse:

  • 88% of physicians report feeling confident (19% very confident) they can identify patients at risk for drug use and misuse; yet,
  • Quest Diagnostics data shows nearly half of all patients (48%) tested in 2020 showed signs of drug misuse. Of these, one in two (50%) engaged in drug combining, a particularly dangerous form of misuse.

Clinical drug testing is deemed critical, but clearer guidelines would help optimize its use:

  • 81% of physicians believe clinical drug testing is critical to preventing overdose deaths and 85% report that such testing gives them confidence they are prescribing safely.
  • Nearly 9 in 10 (88%) believe that better guidelines would help ensure that clinical drug testing is used equitably, and 50% strongly agree.
  • 69% report needing more tools to be able to address racial/ethnic health disparities in prescription drug addiction management.

Moreover, approximately half of physicians (51%) do not follow up with definitive tests when presumptive tests are positive, a potential concern given presumptive point-of-care tests miss a substantial proportion of specimens with fentanyl (74%), the drug responsible for most overdose deaths. The data also found that only about one-third of physicians (34%) said they are very confident in their ability to prescribe naloxone, a medication for opioid overdose, to patients who may be at risk of overdose.  

"COVID-19 exacerbated longstanding public health issues, including mental health, drug misuse and social disparities, while supercharging telehealth, at-home care and other consumer-centric approaches," said Jay G. Wohlgemuth, M.D., Senior Vice President, R&D and Medical, and Chief Medical Officer, Quest Diagnostics. "Our latest Health Trends findings reveal the need to arm physicians with comprehensive resources to identify and combat drug misuse amid this shifting landscape. Such resources may include clearer guidelines on when and how to employ optimal drug monitoring, including both presumptive and definitive testing, as well as guidance on employing telehealth to deliver care for patients taking controlled prescription medications or struggling with substance use disorders."

"Clinical drug testing gives physicians the ability to uncover insights into problematic drug use before the worst outcomes can occur, and our research shows physicians overwhelmingly value clinical drug testing in patient management. Yet there remains an unmet need for clear clinical guidelines regarding when and how to test, which tests to use, and the frequency of testing," said report co-author Jeffrey Gudin, M.D., Senior Medical Advisor, Drug Monitoring, Quest Diagnostics. "Clinical drug testing has the potential to improve patient care and save lives, but physicians need to be empowered to optimize this tool."

"Physicians serve a crucial role in reducing opioid misuse and addiction, but it requires having the right tools and processes in place to help identify at-risk patients," said Creighton Drury, Chief Executive Officer of Partnership to End Addiction. "This has never been more important, as we continue to experience the fallout from the COVID-19 pandemic and are faced with an increasingly dire opioid crisis in the U.S."

About Clinical Drug Testing
Clinical drug testing (also known as drug monitoring) provides objective information that can assist healthcare providers in assessing patients' use of prescribed medications, other controlled non-prescribed drugs and illicit drugs. Presumptive testing methods include rapid point-of-care (POC) devices as well as more sensitive laboratory immunoassays. While POC testing devices (e.g., cups or dipsticks) provide rapid and inexpensive qualitative results (i.e., negative, positive), when compared to definitive testing, they often have lower sensitivity and specificity, which may lead to false-negative and false-positive results and may not be readily available for some of the commonly used and potentially misused medications such as tapentadol, carisoprodol, gabapentin, and emerging synthetic drugs of abuse. Definitive testing utilizes highly complex laboratory instruments to identify and quantify prescription medications, illicit substances, and specific parent drugs and their metabolites often missed by POC testing. Its greater sensitivity can confirm or refute presumptive test results and reduces the occurrence of false positive/negative results. However, definitive testing can take days to produce a result and is typically more expensive than presumptive testing. Definitive testing is recommended for certain situations, such as for a positive or inconclusive presumptive test from a patient showing signs of misuse. To learn more about the different types of drug tests visit

The 2021 survey was conducted online within the United States by The Harris Poll on behalf of Quest Diagnostics from August 12-19, 2021 among 505 physicians who specialize in family practice, general practice, or internal medicine, and are licensed in the state where they practice. Results are weighted for years in practice by gender and region to align them with their actual proportions in the population. Nearly all of the survey respondents (97%) claim to have prescribed opioids or other controlled medications within six months of taking the survey. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated.

The Health Trends laboratory analyses examined de-identified results of patients tested using the proprietary Quest Diagnostics prescription drug monitoring service and the company's medMATCH® reporting methodology for tests of commonly prescribed and abused drugs, including pain medications, central nervous system medications including amphetamines, as well as certain illicit drugs such as marijuana and cocaine.

The study's strengths include its size, geographic scope, multiple years of test results and its use of validated testing by mass spectrometry, the most sensitive and specific drug testing method. Its limitations include geographic disparities and inability to validate or contextualize test results with medical records. 

Quest Diagnostics Health Trends studies are performed on aggregate de-identified data in compliance with applicable privacy regulations and the company's strict privacy policies, and follow procedures approved by the Western Institutional Review Board. For the complete methodology, please refer to the full report at: Quest Diagnostics Newsroom - Health Trends®

About Quest Diagnostics Health Trends®
Quest Diagnostics Health Trends® is a series of scientific reports that provide insights into health topics, based on analysis of objective clinical laboratory data, to empower better patient care, population health management and public health policy. The reports are based on the Quest Diagnostics database of more than 60 billion de-identified laboratory test results, believed to be the largest of its kind in healthcare. Health Trends has yielded novel insights to aid the management of allergies and asthma, cancer, clinical (prescription) drug monitoring, COVID-19, diabetes, heart disease, influenza, Lyme disease, and workplace wellness. Quest Diagnostics also produces the Drug Testing Index (DTI)™, a series of reports on national workplace drug positivity trends based on the company's employer workplace drug testing data. Quest Diagnostics Newsroom - Health Trends®

About Quest Diagnostics
Quest Diagnostics empowers people to take action to improve health outcomes. Derived from the world's largest database of clinical lab results, our diagnostic insights reveal new avenues to identify and treat disease, inspire healthy behaviors and improve healthcare management. Quest annually serves one in three adult Americans and half the physicians and hospitals in the United States, and our 50,000 employees understand that, in the right hands and with the right context, our diagnostic insights can inspire actions that transform lives.

About Partnership to End Addiction
Partnership to End Addiction is a national nonprofit uniquely positioned to reach, engage and help families impacted by addiction. With decades of experience in research, direct service, communications and partnership-building, we provide families with personalized support and resources — while mobilizing policymakers, researchers and health care professionals to better address addiction systemically on a national scale.

*Quest Diagnostics has financially sponsored certain Partnership to End Addiction activities, but not their advisory role in the development of this report. 


i FB, Rossen LM, Sutton P. Provisional drug overdose death counts. Data as of 10/3/21. National Center for Health Statistics. 2021.

ii Niles JK, Gudin J, Radcliff J, Kaufman HW. The opioid epidemic within the COVID-19 pandemic. Pop Health Manag. 2021;24(S1):43-51.


SOURCE Quest Diagnostics