CLN Daily
Opioid-use disorder (OUD) affects millions of people worldwide. Effective treatment is imperative to prevent overdoses and save lives. However, people with OUD face many barriers to care, so a one-size-fits-all approach to treatment may not be sufficient. Instead, several recent guidelines emphasize the need for a patient-centered model of care based on each individual’s unique needs, history, and preferences. The ultimate objective of person-centered care is to improve outcomes by eliminating barriers to treatment initiation and maintenance.
In the context of this changing paradigm, how does urine drug testing (UDT) fit in, and how can clinical laboratories contribute to harm-reduction efforts? These questions were answered during Monday’s Scientific Session, “Person-Centered Care for Opioid Use Disorder: Shifting Roles for Clinical Laboratories and Urine Drug Testing.”
Danijela Konforte, PhD, discussed what this shift means for how UDT results are used. She explained that, historically, the main goal for OUD patients receiving opioid-agonist therapy (i.e., buprenorphine or methadone) has been complete abstinence. When abstinence is the primary objective, unexpected UDT findings can lead to the termination of treatment. Konforte argued that this shouldn’t automatically be the case. Rather, such results should initiate a discussion with the patient about how to adjust or improve care.
“Abstinence may be one option, but it is not the only one,” said Konforte. She pointed out that “noncompliance may indicate that the dosage is not sufficient, so maybe the medication has to be changed.”
To achieve the best outcomes, clinicians must collaborate with individuals, said Konforte. They should discuss exactly what UDT is, how frequently it will be done, and how the results might affect the patient’s care. She also explained that there is no evidence showing that more frequent UDT improves outcomes—which is why the guidelines recommend that clinicians define testing frequency on a case-by-case basis in a way that balances risk of harm with autonomy and convenience. It is important to engage individuals in setting treatment goals that are attainable based on their unique social, financial, and other circumstances.
The second part of this session focused on harm-reduction strategies. Clinical labs play an important role in harm reduction since UDT is a key tool in managing patients undergoing opioid-agonist therapy. Because the unregulated drug supply is increasingly toxic and unpredictable, people may not know exactly what’s in the drug they are taking, Konforte explained.
To reduce drug-associated harm, laboratories performing UDT should update their menus regularly. Up-to-date menus provide clinicians with the results they need to treat overdose or withdrawal and enable them to educate patients about drug-specific risks. Sharing examples from her own experiences, Konforte highlighted how laboratories can leverage data from drug-checking programs to better understand the local drug supply and modify their menus accordingly.
One of the most significant barriers to care is the negative stigma surrounding OUD. In the last part of the session, the speaker engaged attendees in an evidence-based discussion about the power of using destigmatizing language as another harm-reduction tool. She shared some non-stigmatizing terminology endorsed by the National Institute on Drug Abuse, such as using the term “unregulated drugs” instead of “illicit drugs” or “drugs of abuse.” Such terms can be adopted by laboratorians, vendors, clinicians, and families in efforts to put the individual in focus rather than emphasizing the disease. “Language matters,” said Konforte.