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2. Quest Diagnostics Fighting Opioid Abuse with Objective Information
Presented by:
Michael E. Prevoznik
Senior Vice President and General Counsel
July 31, 2017

3. Quest Diagnostics
World’s leading diagnostic information services provider
$7.5 billion in revenues; 43,000 employees
Operates 2,300 patient service centers
Employs over 650 MDs and PhDs
Serves 50% of U.S. physicians and hospitals annually and 500k + patients per day
Maintains the largest private laboratory database with 40 billion de-identified test results and growing at the rate of 3 billion new results per year
Advocates for clinically and fiscally appropriate drug testing as part of any response to the opioid crisis
Drug testing generates objective information to help:
Health care providers better treat and monitor their patients
All levels of government monitor and address the epidemic of prescription drug misuse and abuse

4. Robust Opioid Solutions Must Include Drug Testing
Value of drug testing in treatment and monitoring of patients:
Provides objective information for health care providers to assess patient drug use and misuse
Alerts providers if patient is not taking prescribed medication and possible diversion risk
Augments existing subjective tools (e.g. patient medical history, risk assessment, etc.) that providers use to determine patient risk for drug misuse
Self report of drug use has limited validity
Monitoring behavior alone can fail to detect problems revealed by drug testing
Assists providers to make appropriate evidence-based decisions prior to and throughout treatment
Non-opioid therapy
Opioid therapy
Referral for Substance Use Disorder treatment
Helps maintain the provider-patient relationship
Creating mandatory testing guidelines for all patients on opioids may help de- stigmatize the testing and help the provider maintain trust with her patients

5. Guidelines for Opioid Patient Treatment and Surveillance Must Include a Role for Drug Testing
CDC’s opioid guideline calls for baseline and periodic drug testing (2016)
Federation of State Medical Boards guidelines are similar to CDC’s (2017)
U.S. Depts. of Defense and Veterans Affairs: baseline and ongoing random drug testing (2017)
Some States have adopted drug testing guidelines, but have taken different approaches. For example:
Oregon: adopted CDC guidelines (2016)
Washington: baseline and periodic drug testing (frequency based on patient risk assessment) (2015)
Virginia: baseline testing and retesting for chronic pain or addiction patients every three months in the first year and six months thereafter (2017)
But many states have not yet included a role for drug testing as part of the solution in fighting the opioid crisis

6. Drug Testing is a Trusted Source of Objective Information that can be Part of an Effective Health Surveillance Program
U.S. Department of HHS identified a national priority to strengthen its understanding of the opioid epidemic through better health surveillance
Quest Diagnostics Drug Testing Index:
Published annually for 29 years
Relied upon as a public service by government, employers and policymakers
Quest Diagnostics Prescription Drug Monitoring Report
Published annually for 5 years
Next report will be published in September 2017

7. Results of >3,000,000 2015 Patient Drug Tests
Quest Diagnostics 2016 Prescription Drug Monitoring Report: Prescription Drug Misuse in the U.S. is Pervasive
Results of >3,000, Patient Drug Tests

8. Quest Diagnostics 2016 Prescription Drug Monitoring Report
California

9. How Quest Diagnostics Can Partner With You
State Prescription Drug Monitoring Programs (PDMPs):
Help prescribers identify patients who are “doctor-shopping” or who might need substance use disorder treatment
Help government agencies and medical licensure boards monitor prescribing practices and identify unusual prescribing patterns
Inform community-based prevention strategies
Drug testing provides objective information that complements state PDMPs:
PDMPs cannot tell if the patient adhered to the drug regimen or misused or diverted the drugs

10. How Quest Diagnostics Can Partner With You
Quest Diagnostics can partner to provide tailored reports at the local, state and federal government level
Quest data can assist in identifying trends of drug use and misuse and in turn can better inform decisions about training and healthcare resource allocations
Quest’s medical and scientific experts can assist in developing and refining policy and surveillance
Explore expanding scope and use of court-ordered drug testing
Quest Diagnostics is a Reliable Partner: Per CMS data, for the typical prescription drug monitoring patient, certain competitor labs billed for on average 8x more services per patient than Quest, receiving 4x higher Medicare payment per patient than Quest
Quest Diagnostics thanks the Attorneys Generals for their efforts in routing out fraud and inappropriate testing in the lab industry

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