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K11 Dr Joseph Stanton

K11 Dr Joseph Stanton

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Evaluation of national, regional, and state drug abuse trends utilizing near-real-time urine drug test results

Dr Joseph Stanton

Saturday, October 10th, 2020  |  2:00 pm EST

Learning objectives:

After this session, participants will be able to:

  1. Describe the landscape and trends in illicit substance use in patients seeking healthcare at a national, regional and state level;
  2. Demonstrate the significant changes seen in drug use during the COVID-19 pandemic;
  3. Identify the frequency of drug detection among patients prescribed buprenorphine/naloxone for medication-assisted treatment.

Presentation Summary

This presentation provides an important, in-depth look at national, regional, and state drug use trends utilizing a proprietary database of near-real-time, definitive urine drug test results. The presentation focuses on these specific topics: National, regional, and state findings for the use of non-prescribed fentanyl, fentanyl analogs, heroin, cocaine, and methamphetamine; co-positivity rates of non-prescribed fentanyl with select drugs of abuse geographically; COVID-19’s influence on positivity rates for these drugs of abuse; and the frequency of drug detection among patients prescribed buprenorphine/naloxone for medication-assisted treatment.



While it’s understood that there is no single solution to the current opioid epidemic, the last few years, and the emergence of the COVID-19 pandemic in 2020, have led to dramatic shifts in drug abuse trends. Between 2017 and 2018, overall drug overdose deaths declined by 4.1%; however, preliminary data for 2019 suggest that drug overdose deaths reached a record high, increasing 4.6% from the prior year.  This upward trend appears to continue in 2020, as public health officials across the country report spikes in drug overdoses that appear to be associated with the COVID-19 pandemic.

While illicit fentanyl is the major contributor to the current surge in drug overdose deaths, it is important to characterize the emerging combinations of other illicit drugs with fentanyl, which increase the risk of overdose.

We must also consider that overdoses with stimulants are on the rise as well. According to CDC data, the number of overdose deaths involving cocaine more than tripled from 2012 to 2018, while deaths associated with psychostimulants (primarily methamphetamine) have increased nearly five-fold during that same time.

Despite government policies limiting sales and availability of precursors used to make methamphetamine, data submitted to the National Forensic Laboratory Information Systems identified it as the top drug submitted to local and state laboratories by law enforcement in 2018, comprising 24% of total drug reports. Still, much of the observed rise in stimulant-related drug overdoses deaths have been attributed to the involvement of fentanyl.

Of equal concern, is the emergence of fentanyl analogs, which often have significantly increased potencies that increase the risk of overdose. Fentanyl analogs can be created by adapting fentanyl synthesis methods with minor variations, but the scope of why and how those techniques are employed remains unclear.

Deaths related to fentanyl analogs nearly doubled between July 2016 and July 2017, but little is known about their prevalence in a population seeking healthcare. Furthermore, the continual crisis of misuse and overdose has led to an increase in buprenorphine dispensing rates for the management of opioid use disorder. Published literature has shown that self-reporting of medications and/or substance use is not reliable in numerous healthcare populations, including patients with substance use disorder.

Since patients prescribed buprenorphine/naloxone for opioid use disorder may relapse by taking non-prescribed medications or illicit drugs, understanding the distribution of drug use in this patient population could be useful for in awareness to prescribing clinicians.

Through data provided by federal and state agencies, as well as analyzed urine drug testing samples, this program will illustrate how usage patterns are shifting but provide useful objective information to support improved clinical decision making.


Author bio

Dr Joseph Stanton

Joseph Stanton is the Associate Director of Clinical Affairs with Millennium Health. Dr. Stanton has over a decade of clinical research experience in chromatography, mass spectrometry, toxicology and pharmacogenetics. At Millennium Health, Dr. Stanton collaborates with various departments including, education, sales, marketing and R&D aimed at improving clinical outcomes for people suffering with pain, addiction and other mental health disorders. Dr. Stanton joined Millennium Health in 2014 and since then has educated thousands of clinicians across the country on the importance of laboratory clinical interpretation to improve patient outcomes. Prior to joining Millennium Health Dr. Stanton completed his doctoral research at the University of Maryland School of Pharmacy and School of Medicine.