According to the American Society of Addiction Medicine, (ASAM) while the urine test is an essential component in the management of substance abuse disorder, it should be set aside when a public health emergency such as the COVID-19 pandemic arises. The facilities for treating addiction should be made available to patients who are in danger of losing their lives.
To show its earnest desire to support the American people in its battle against COVID-19, the ASAM developed a drug testing protocol which is aimed to establish balance between obtaining data from a drug test against the risk of exposing patients and laboratory/clinic staff to COVID-19.
To minimize viral transmission and stop the movement of coronavirus, ASAM identifies these scenarios where drug testing may be paused or deferred in clinical practice:
- In communities where COVID-19 transmission is confirmed, patients should be given continued access to pharmacotherapy for addiction. They shouldn’t be required to go to a treatment facility or submit a sample to be tested for drugs. This is also applicable in cases when supplies of personal protective equipment are low.
- Requiring patients to go to a health care facility to submit samples for drug testing may expose them to risks instead of benefits. Their travel to or mere presence in health care facilities can expose patients to the coronavirus. Without the right personal protective equipment, the laboratory and clinic staff increase their risk of getting exposed to COVID-19 as they interact with people providing a specimen.
- Health care and drug testing providers are enjoined to carefully assess the risks as well as the benefits of drug tests not only for the patient but for their entire community. As a general rule, any test that is not intended to be the basis for changing a patient’s management should not be done.
Situations Where Limited Drug Testing may be Allowed:
The ASAM asserts that even as COVID-19 cases continue, there may be several scenarios when the need to go through a drug test outweighs the risk of getting exposed to COVID-19. This is applicable to:
- Patients who are known or suspected to divert medication that’s intended to treat drug addiction
- Patients who present themselves to a treatment facility and manifesting signs of intoxication
- Patients who have a case of drug overdose whether self-reported or not
- Patients with unstoppable opioid or drug abuse disorders
- Patients who are dependent on opioid and other prohibited substances
To minimize drug testing during the COVID-19 crisis, clinicians are encouraged to use other methods of obtaining information regarding adherence to medication. They also need to obtain information about patient safety which is an important element in forming medication management decisions to reduce a patient’s reliance on drug testing. Here are some alternative strategies ASAM is recommending to achieve this end:
- If applicable, both patient and provider should agree that the former will perform addiction treatment by means of self-administration. Provided that it is virtually observed by the drug testing service via a video telehealth platform.
- The patient’s family members or loved ones should be involved in the patient’s treatment program.
- Health care providers should connect with patients more often by means of phone or other telehealth methods, especially with those who may be struggling with their addiction.
- If an upsurge of in-person visits to treatment facilities trigger an increase in the risk of COVID transmission, the heath care provider should reduce the dose of the patients’ medication and consider delivering their medication as an alternative.
If drug testing in a treatment facility is allowed, the drug testing facilities must ensure that they have the required staff, supplies and protocols necessary to conduct the procedures. Above all, they must ensure adherence to safety, sanitation and infection control practices recommended by the Center for Disease Control (CDC). This practices include:
- Providing staff in charge of collecting samples with sufficient personal protective equipment (PPE) such as face masks, lab gowns, face shields and gloves.
- Use of low-cost testing metrics that detect sample dilution or alteration. This eliminates the need for observed sample collection.
- Enforce physical distance of six feet between laboratory/clinic staff and patients at all times
- Sanitize areas where samples are collected as well as commonly touched surfaces.
It is expected that collecting samples per patient will take more time with the sanitation procedures in place. Hence, it is the responsibility of the drug testing service to prioritize patients according to circumstances and need. If this situation arises, the provider may temporarily defer routine drug testing to accommodate urgent cases.
ASAM-Recommended Actions for Results in Persons Treated with Opioid Agonist Medications
If drug testing operations are resumed and a patient being treated with opioid medication unexpectedly gets a negative result, the provider should consider these steps:
1. Consider if the patient has severe opioid use disorder that warrants against medication.
2. Check for reasons that trigger the negative result, including:
* The patient took excessive amounts of the medication and ran out of it before producing his sample for the test.
* The patient isn’t taking enough of the medication leading to his body’s failure to absorb sufficient amounts to permit detection of the sample during the test
* The sample tested did not come from the patient
3. The provider should talk to the patient to determine possible reasons for the negative result.
4. Based on results of his interview with the patient, the provider should consider making adjustments to the patient’s treatment plan.
5. The provider should assess whether it is beneficial for the patient to be observed for medication dosing.
6. If the provider has evidence that the patient is diverting medication despite their efforts to produce an effective treatment plan, the provider may stop the medication because it no longer serves its purpose for treating the patient’s OUD.
7. The provider should evaluate the patient’s opioid use disorder to determine if it could be treated more effectively with another medication.
Due to the risks posed by the COVID-19 contagion, ASAM enjoined health care and drug testing facilities should consider options for drug testing without making close contacts with patients. These drug testing alternatives are currently being considered:
Patient’s Samples Should be Collected Outside of the Treatment Facility
There are patients who need drug testing as a primary requirement for a continuing medical treatment. For cases like this, the collection of patients’ samples can be done in a different location. This should help to reduce contact between the patient and lab staff.
Drug Testing from Home
You may find it amazing, but technology has made it possible for anyone to conduct drug testing in the comfort of their home. This could certainly help patients to avoid contact with other people and avoid the risk of getting the coronavirus.
There are different types of drug tests that can be performed at home. These are:
- Urine drug test
- Saliva drug test
- Hair drug test
- Substance test
- Alcohol test
- Nicotine test
Samples that are found to be preliminary positive are however still subject for confirmation by a laboratory.
At-home drug testing kits are accurate. They are also recognized by the Food and Drugs Administration (FDA).
In a world overflowing with illegal drugs, it has become almost impossible to live and work harmoniously with other people. It has in fact done a great deal of damage not only to business but to the lives of affected individuals and their families. We should work together to resist it. Let’s do it with the help of trusted drug testing providers.