The pandemic has made our drug problem worse. Why don’t doctors use clinical drug tests?

In 2020, Covid-19 caused a delay in non-emergency in-person medical care and simultaneously exacerbated contributors to substance use disorders, including job loss, economic hardship, and mental health issues.

Now we see the tragic result: drug overdoses claimed nearly 100,000 lives between April 2020 and April 2021, according to the CDC, sparking new urgency in the fight against the drug crisis. A health trends report from Quest Diagnostics found that 70% of physicians fear they have missed signs of drug abuse during the pandemic, and the vast majority fear that overdose deaths will continue to rise even if the pandemic subsides.

For people with substance use disorders, treatment often begins in the back of an ambulance or emergency room. Unless we do a better job of preventing these troubles, our country will never get ahead of the drug crisis and many more lives will be lost.

One of the only tools doctors have to identify potential drug abuse is clinical drug screening. Many of today’s overdose deaths began with the prescription of an opioid, benzodiazepine or other controlled drug. Screening and monitoring for illicit and prescription drug abuse allows physicians to intervene early, before the dangerous drug combination, substance use, or overdose occurs. Clinical drug testing is an essential tool in the fight against the drug crisis. According to the report, 81% of physicians believe that clinical drug testing is essential to prevent overdose deaths and 85% say the tests give them confidence that they are prescribing safely.

Clinical drug testing often involves two testing methods. Usually, a presumptive screening test is done first. If the presumptive results indicate cause for concern (ie, a positive result for a non-prescribed sedative), the next step may be a definitive laboratory test to confirm the results. This definitive test is more sensitive and provides granular information about the drug or drug metabolites present.

For clinical drug testing, presumptive and definitive testing should be performed on the same sample to confirm test results and reveal behavioral information. The same sample test also mitigates potential difficulties for patients who lack the time, money and transportation to make repeat office visits.. The report found that 60% of doctors are concerned that patients will return to provide a second sample if presumptive and definitive screening tests take place on samples taken on different days.

Although clinical drug testing is an essential part of care, there are no clear guidelines on testing methods and frequency. Physicians may use tests in ways that fail to maximize their clinical value, and some bad actors may overuse services for their own financial gain. Health plans seeking to limit inappropriate use may inadvertently implement policies that restrict physicians’ access to medically appropriate tests. In the report, 88% of physicians expressed their belief that better guidelines would help ensure fair use of clinical drug testing.

Clinical drug testing allows doctors to uncover potentially problematic drug use and anticipate devastating consequences. Doctors appreciate these tests, but they also want clearer guidelines to optimize their use. Now that government stay-at-home orders have ended, policies that minimize non-essential care, including clinical drug testing, need to be reconsidered. Preserving physician choice and patient access to medically appropriate testing is critical in this perilous time for the nation’s drug crisis and pandemic recovery.

Photo: invincible_bulldog, Getty Images

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