According to a December 2016 Morbidity and Mortality Weekly Report, opioids in 2015 accounted for more than two-thirds of all drug overdose deaths in the United States, 15.6% more than the previous year, and drug overdose deaths nearly tripled between 1999 and 2014. However, according to a recent article in Clinical Laboratory News, opioids remain a mainstay of pain management, upping the stakes for monitoring prescription compliance and detecting abuse.
At Mayo Clinic, physician calls for help interpreting pain-management tests increased after the Centers for Disease Control and Prevention in March 2016 issued guidelines recommending urine drug testing before starting patients on opioid therapy and for monitoring them afterward.
According to Paul Jannetto, Ph.D., Director of the Clinical and Forensic Toxicology Laboratory at Mayo Clinic, "This guideline and others are driving the testing but also leading to more confusion in terms of which type of laboratory tests to use—for example, immunoassays versus definitive methods; which specific tests to include; the frequency; and how to interpret those tests.”
Mayo offers many tools to help providers navigate the nuances of drug testing, including its online test catalog used to interpret drug tests for compliance, 5- to 15-minute “hot topic” videos, and other online education. Mayo consultants also make in-person and online presentations, in addition to phone consultations. According to Dr. Jannetto, real-time conversations represent almost half of their daily calls. “It’s an important and core component of our job,” he said.
In addition to educating and consulting closely with physicians and tweaking testing menus, labs might also take a close look at their testing methods. Loralie Langman, Ph.D., Consultant in the Department of Laboratory Medicine and Pathology at Mayo, said that while mass spectrometry for both screening and confirmatory testing is considered, it is not an absolute must.
“Our recommendation, if at all possible, is to do definitive screening as the first-line approach. That frequently, but not always, is a mass-spec-based approach,” Dr. Langman said. “There is still a role and place for immunoassay-based screening when mass spec isn’t necessarily available.”