The COVID-19 pandemic has forced providers to develop creative adaptations to activities usually conducted in person, from moving group therapy sessions to telehealth platforms to building an onsite grocery store for residential patients.
Add drug screenings to the list services now being conducted remotely.
In late April, the American Society of Addiction Medicine published guidance on patient care in response to the pandemic. Noting that “requiring patients to present to a healthcare facility to provide urine or saliva samples for drug testing may be more harmful than beneficial” given current events, ASAM recommended in its document that substance use disorder treatment providers explore alternatives to their standard operating procedures. This includes pausing testing for low-risk patients, identifying alternative means for obtaining information about medication adherence, and exploring options for drug testing at a distance.
A pair of vendors in the space—Genotox and Dominion Diagnostics—are among those that began developing remote drug screening services prior to the onset of COVID-19 in the U.S. Once the pandemic hit, however, the sense of urgency among providers to begin figuring out a remote alternative to their traditional screening methods surged.
“Providers, at different rates, are realizing this [pandemic] isn’t going away tomorrow,” Genotox Laboratories chief operating officer Shawn Lunney tells Addiction Professional. “They say, ‘I don’t think I’ll be back to having all patients in the office any time soon. How do I adjust and adapt so that I can continue to deliver care?’ The first week or two, people were in hunker-down mode. Each week since, we’ve seen additional clients say how do we get this going in my practice?”
Genotox offers Truth, an at-home urine drug testing service that utilizes DNA authentication technology known as Tox Direct. The service allows patients, who are directly sent kits, to provide urine samples from home unobserved. The samples are DNA authenticated to the donor, and the screening identifies attempts to substitute synthetic urine, as well as pill scraping, dilution and oxidizer adulteration. The test detects 110 drugs of abuse, medications and metabolites with a detection window of 3 to 7 days. Results are provided with 48 hours.
One of the freeing aspects of in-home testing, Lunney says, is that providers can somewhat combat the issue of timing by having random tests during the window, which could make it an attractive solution beyond the time of the pandemic.
“From a scientific perspective, if your clinical objective is to catch people doing things they’re not supposed to, a random test administered between visits with DNA authentication is a more robust solution than having them come into the office and [urinate] into a cup on a day prespecified weeks in advance,” he says. “If everybody is really interested in having the highest level of resolution and the most accurate drug test, you could see this sticking around and having long-term potential.”
Dominion Diagnostics, meanwhile, rolled out its Positive Outcomes remote screening program in partnership with Geisinger more than a year ago. The program, which is now used in five states, allows clinicians to provide a testing kit to patients in recovery who have been prescribed addiction treatment medication and have stabilized. Patients and providers are notified at random intervals when a patient is due to provide a test sample. Through the use of telehealth platforms, providers have the option of observing the patient providing an oral fluid sample and putting the device in a mailer to be sealed and sent out.
Prior to the onset of the COVID-19 pandemic, some insurers were resistant to signing off on oral fluid testing, viewing it as experimental, but most have now shifted and said they would pay for it, says Mary P. Hauser, MA, Dominion’s vice president of addiction services and new market development. Dominion also offers an option for testing with a urine sample.
Hauser says most practices have taken a combination of oral fluid and urine testing kits to determine which is the most effective solution for their practice. One practitioner in Illinois uses both options on a patient-by-patient basis, Hauser says.
“The programs looking at adding telehealth or telecounseling to their milieu of offerings, they want a lab that is going to keep up with them and complement the service, and not make it cumbersome for the patient or the clinician; ease the process,” Hauser says. “That’s what Dominion has done in trying to stay ahead of the curve.”
Having worked on remote testing solutions prior to COVID-19 was a “huge advantage” for Dominion, Hauser says, adding that providers who are looking to implement remote screenings into their practice should aim to work with vendors who are adaptable in their approach.
“That’s our message to any program: Work with a laboratory that is willing to meet the needs of the program and has enough flexibility and has thought through creatively how these solutions could work and make sure it fits their population’s needs,” she says. “There’s not one solution.”