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Drug Screening and Laboratory Testing News

Pain Management, March 2011, Volume 4, Issue 2

News and the latest updates on developments in alcohol and drug testing.

News and the latest updates on developments in alcohol and drug testing.

The University of Wisconsin’s Center for Health Enhancement Systems Studies is putting the efficacy of mobile health care technology to the test by offering recovering alcoholics access to a smartphone app that will provide consistent “24-hour, in-home (or anywhere) access” to a relapse prevention system.

Researchers posit that “cost, geographic distance, lack of time, and peer support can reduce participation” in aftercare programs, and also that ready access to the resources that this tool can provide “will improve competence, relatedness, and autonomy which will reduce the days of risky drinking over a 12-month period.” The Addiction Comprehensive Health Enhancement Support System (ACHESS) includes:

  • Communication with peer support groups and addiction experts
  • Timely monitoring to assess risk of relapse
  • Reminders and alerts to encourage adherence to therapeutic goals
  • One-touch communication with a care manager

The trial is recruiting 280 patients from CAB Health and Recovery Services, Boston, MA, and Fayette Companies, Peoria, IL. The system will also be tested as part of a four-month pilot involving 30 offenders in the Ayer Concord Drug Court Program (ACDCP) in Massachusetts. “Being able to reach out during times of risk can be a key factor in maintaining sobriety, and this tool can make that call for help much easier,” said ACDCP program director Hilary Curtis.

Are Some Patients Aware They Are Being Drug Tested without Consent?

Testing for illegal drugs in the ER may seem routine to you, but your patients may not even be aware of this widespread practice, or that it could be done to them without consent. An excellent explanation of why such testing is standard operating procedure, is presented in a Time magazine piece by Zachary F. Meisel, MD, an emergency physician at the University of Pennsylvania.

Meisel wrote that testing for illicit-drug use “is something we can and often do. And in many cases, it’s done for a good reason.” Confusion, excessive sleepiness, or unexplained “flipping out” require that doctors know “right now” whether these symptoms are the result of alcohol use, stroke, or seizure.

The basic need for ER drug screens is evident, but Meisel doesn’t approve of the practice with a paternalistic rubber stamp. He also highlighted the ethical implications of their overuse, which can blind practitioners to the downsides of the tests.

“First there are ethical issues of autonomy and confidentiality,” he wrote. “While the Health Insurance Portability and Accountability Act legally protects all medical information from public disclosure, just ordering the test increases the risk that a breach of confidentiality could expose this sensitive information.” Second, the drug screens result in false-positives and contribute to “cognitive biases [and] mental prejudices on the part of doctors that can interfere with our ability to make the best decisions for our patients.”

For example, if a patient with stomach pains tests positive for cocaine, “she becomes the ‘drug user in Room 2.’” This is not how “priorities in care should be determined,” he said. An “unbiased assessment of urgency” should rule the day, but personal habit and bias can be notoriously hard to change.

Unfortunately, Meisel offers just such a solution to the problem, but because he stresses that “legal or regulatory barriers to drug tests are a bad idea,” what other options are there? “Just like everything else we do in medicine, the risks and benefits need to be weighed ahead of time. Drug-testing needs to be put to the same measure.”

From the Literature

Urinary Ethyl Glucuronide and Ethyl Sulfate Testing for Detection of Recent Drinking in an Outpatient Treatment Program

In this admittedly limited study, researchers indicate “that urinary EtG and EtS testing is a useful tool for objective identification of recent drinking in outpatients treated for alcohol and drug dependence.”

MDMA and Methamphetamine: Some Paradoxical Negative and Positive Mood Changes in an Acute Dose Laboratory Study

“In the laboratory, acute methamphetamine led to significantly higher positive moods. However, against expectations, MDMA did not generate a significant increase in positive moods.”

Acceptability of Drug Testing in an Outpatient Substance Abuse Program for Adolescents

Adolescents were willing “to participate in a drug testing program that requires frequent urine specimens and reports results to parents. Future studies should determine how this program affects treatment outcomes and whether this program is feasible in primary care.”