Among the countless impacts of the COVID-19 crisis on addiction treatment operations, providers suddenly have had to rethink standard protocols for patient drug testing. The vice president of addiction services at Dominion Diagnostics tells Addiction Professional that an immediate effort to protect patients and staff caused a noticeable drop in testing volume, with a number of changes now being implemented as programs seek to resume testing safely.
The overall clinical message has become one of cutting back on testing where possible, says Dominion's Mary Hauser. For more stable outpatients who have been in longer-term treatment, it might make sense for example to reduce testing to a monthly frequency in conjunction with a medication check, she says. For patients who are struggling, however, creative strategies to maintain regular testing are needed.
Dominion is working with some of its treatment program clients to facilitate patient visits to a patient service center rather than the treatment clinic for testing. The company is conducting a rapid ramp-up of these sites, where patients will have to make appointments available at staggered times in order to limit crowding, Hauser says.
At one of its Mid-Atlantic client programs, Dominion has set up a patient care center directly in the facility, Hauser says.
The American Society of Addiction Medicine (ASAM) this week issued updated guidance on drug testing protocols during the coronavirus crisis. Focused largely on outpatients receiving buprenorphine treatment for opioid use disorder, the language suggests it may be more harmful than beneficial at this time for patients to present to a health facility for urine drug testing.
“While urine drug testing is generally an important part of buprenorphine treatment, during a public health emergency, urine drug testing should not be a required part of treatment,” the guidance from ASAM reads.
ASAM suggests that programs explore options for testing at a distance, with any alternatives emphasizing minimal contact between staff and patients as well as reduced burden on local labs. Given the logistical barriers that make urine testing at a distance not feasible, ASAM proposes that wider use of oral fluid-based testing and home breathalyzer tests be considered at this time.
But while oral fluid testing may offer an alternative for some programs, Hauser says, an overall lack of insurance coverage for the practice poses a major obstacle to widespread conversion from urine to oral fluid testing.
Monitoring of an oral fluid test via telehealth is feasible, as a program staff member could watch a patient use the swab and place it in a collector for transport to a lab.
Field leaders struggle to recall a comparable time of upheaval in the industry's history. Hauser says about the closest comparison to COVID-19 involved the earliest reporting on the HIV/AIDS threat and how the uncertainty affected providers.
“We were all scrambling to figure out how to keep staff safe,” she says, at a time when details about the ways HIV could be transmitted remained unclear.
In this respect, there is a parallel to drug testing today, as ASAM references in its guidance. It states that because of uncertainty about COVID-19 transmission, the Centers for Disease Control and Prevention (CDC) recommends taking precautions with any collection of bodily fluid samples.
Hauser expresses confidence that one consequence of the present crisis will be an affirmation of telehealth's role in behavioral health services. If good outcome research can be put behind it, “it will be a modality of care to add to the toolbox,” she says.