The COVID-19 pandemic has forced providers to develop creative adaptations to activities that are usually performed in person, from relocating group therapy sessions to telehealth platforms to deployment a local grocery store for inpatients.
Add drug screening to the list of services that are now performed remotely.
In late April, the American Society of Addiction Medicine published guidelines on patient care in response to the pandemic. In light of current events, ASAM recommended in its document that providers of substances for the treatment of substance disorders should consider alternatives to their standard operating procedures, according to which "patients must appear in front of a health facility to provide urine or saliva samples for drug tests". This includes stopping tests for low-risk patients, identifying alternative ways to get information about drug compliance, and exploring options for drug testing remotely.
Two space vendors – Genotox and Dominion Diagnostics – are among those who began developing remote drug screening services before the outbreak of COVID-19 in the United States. After the pandemic, however, the sense of urgency among providers
began to find a distant alternative to their traditional screening methods.
"Vendors at different rates realize that [pandemic] won't go away tomorrow," Shawn Lunney, Genotox Laboratories' chief operating officer, told Addiction Professional. "They say," I don't think I will have all the patients in the office again soon. How do I adjust so that I can continue to provide care? “In the first week or two, people were in hunker down mode. Since then we have seen additional customers every week saying how we can get this going in my practice. "
Genotox offers Truth, a home urine drug testing service that uses DNA authentication technology known as Tox Direct. The service enables patients who are sent kits directly to provide urine samples from home. The samples are authenticated to the donor, and the screening identifies attempts to replace synthetic urine, pill scratching, dilution, and adulteration. The test detects 110 drugs, medications and metabolites with a detection window of 3 to 7 days. The results are delivered in 48 hours.
One of the liberating aspects of in-home testing, according to Lunney, is that vendors can use timing tests to tackle the timing problem somewhat, which could make it an attractive solution beyond the time of the pandemic.
"From a scientific perspective, a random test between visits with DNA authentication is a more robust solution if your clinical goal is to catch people doing things they shouldn't do than when they come to the office and [urinate] in a cup on a day set weeks in advance, ”he says. "If everyone is really interested in getting the highest resolution and most accurate drug test, you can see that it stays that way and has long-term potential."
Dominion Diagnostics introduced its remote screening program Positive Outcomes in collaboration with Geisinger more than a year ago. The program, which is now being used in five states, enables clinicians to provide a recovery kit to patients in recovery who have been prescribed addiction medication and who have stabilized. Patients and providers are notified at random intervals when a patient should provide a test sample. By using telehealth platforms, providers have the opportunity to watch the patient provide an oral fluid sample and place the device in a mailer to be sealed and shipped.
Before the COVID-19 pandemic broke out, some insurers were unable to view oral fluid tests 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 the opportunity to test with a urine sample.
According to Hauser, most practices have used a combination of oral fluid and urine test kits to determine which is the most effective solution for their practice. A Illinois practitioner uses both options from patient to patient, Hauser says.
“The programs that aim to expand their range of products with telemedicine or telecounseling want a laboratory that keeps pace with them and complements the service and does not make it cumbersome for the patient or the clinician. Make the process easier, ”says Hauser. "Dominion did this to stay one step ahead of the curve."
Working on remote test solutions prior to COVID-19 was a "big advantage" for Dominion, "says Hauser. Vendors who want to implement remote screening in their practice should aim to work with vendors who are adaptable in their practice approach.
"This is our message to every program: Work with a laboratory that is ready to meet the program's needs, has enough flexibility, and has been creative about how these solutions work and ensure that they can Meet population needs, ”she says. "There is no single solution."