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Advances in testing

How have innovation and technology impacted drug testing and the rehab sector over the past decade? How important is testing to integrity of addiction services?

Drug and alcohol testing has been a part of addiction and recovery for as long as I can remember. I started working in the business in the mid-1990s, for employers. Testing was essential, in that industries needed to ensure they had alcohol- and drug-free workplaces. At the start of this millennium, I started getting involved in the addiction and recovery industry. Substance testing is an important tool in monitoring compliance and adherence to a programme, without which you’re just going to be making guesses.

A lot of people say to me that they’re not really interested in looking at drug testing or that they have a pre-disposition about it because it violates privacy and fosters a negative approach to treatment. They’ll say they’ve been in the business for a long time and can tell when somebody is using. Although professionals treating patients in recovery can have a keener sense in spotting drug and alcohol use, there is no way to confirm that for external authorities without hard clinical evidence and data.

What main difference have you noticed between US and UK treatment centres?

In the US, drug monitoring is well accepted, with most people in recovery realising that they will have to be tested. It’s a bit more mature than in the UK, where there is a pervading issue of people feeling their privacy is being invaded. But laboratories are not trying to invade privacy or publish anything about patients that would affect their everyday life. Labs simply produce data to help plan treatment. That’s what the industry is about – it’s a data driven industry.

We only put numbers out. We don’t look at who it came from, where it came from or the type of test it is. We just develop data for the counsellors and doctors to better treat patients.

What is Routine Medication Monitoring?

We look at working with ethical organisations round the world to help build programmes to educate medical professionals that treat addiction and do so in an economical and effective way. We don’t even call our programmes drug testing – we coined the term Routine Medication Monitoring. It is important that we look at medical necessity to treat the patient for what they might be addicted to. Testing helps medical professionals determine the problem, then prepares a way to treat it.

With most diseases, your doctor would perform a battery of tests to determine if you have the disease and extent of the disease, then develop a treatment plan. Addiction needs the same consideration when diagnosing. Patients then realise that they’re going to get the best possible outcomes while maintaining their dignity. We’re trying to help people – with an overall goal of a consistent treatment protocol internationally.

How have innovation & technology impacted drug/ alcohol testing and rehabs in the past decade?

It has changed tremendously. When I started, there was basically only one way to do a test: with an immunoassay. This was a screening device, like an instant test cup or a tabletop analyser that would analyse a specimen and determine if a drug was present or not, but it wouldn’t specify what drug or type of drug.

The best analogy for immunoassay results is telling a friend you’re going to Wembley Stadium but could not say where you sit. For example, you could have a positive opiate but not know if it was heroin or poppy seeds from a bagel!

Confirmation is a much deeper science and helps to distinguish what actual drug is present. Going back to the analogy above, using lab confirmation technology you could tell your friend that you were in Wembley, what section, row and seat – and probably what you ate. This is important for medical professionals to help them determine what medications their patients are on and taking correctly and which they might be taking without consent.

In many cases it’s innocent but adverse drug reactions are a big problem. Multiple physicians can prescribe medications, not knowing what each is prescribing. Self-medicating is a problem as well. These tests help distinguish what’s present and what might not work well together.

What other trends have you seen over the past decade or more?

In the US, when pain care medicine became prevalent in 2004-2005, we started seeing big issues. An even bigger problem was diversion – when somebody obtains a medication, but doesn’t necessarily take it but instead sells it on the street. It’s a huge problem because these drugs were prescribed to resolve a problem like a pain issue or depression.

Medications sell at a premium on the streets and are a gateway to more illicit drug use. This is where the drug-testing industry started having an important place in the market. “Doctor shopping” was popular and diversion rampant.

Then there are pregnant women who use marijuana, which is stronger than ever. Statistics show that marijuana is more of a gateway drug than previously believed – and it is only one of many drugs that pregnant women can use. There will be adverse effects on the baby.

We’re trying to get a reasonable testing protocol based on medical necessity for each patient that takes into account many variables. These variables include type of testing, how to test, when to test and frequency of testing. In the past that’s been the biggest problem: labs have had protocols that say you should test for every drug that’s out there, three or more times per week. That is unnecessary: there are ways to moderate and cost contain while still obtaining valuable treatment data.

What does the future hold for drug/alcohol testing?

It’s unfortunately an endless market. As long as the supply and the demand are there, we will have addiction problems. Simultaneously, we need to treat people and do so with compassion while preserving dignity. We need to put our minds together and bring treatment testing together, with a set protocol that will work and enable the job to get done. Medical professionals on both sides of the Atlantic need to look at this and find a way to put together a cohesive policy to treating that disease. Routine Medication Monitoring is an essential tool in developing data and ultimately a care plan for people suffering from this disease.

On a broader scale, there needs to be a real dialogue between leaders of the US, the UK and the rest of Europe about this ongoing problem of drug abuse. It’s at epidemic proportions in almost every country. Even in my small town in New Hampshire, we’re seeing unexpected, dirty drugs coming over from Eastern Europe. There is a worldwide connection to the drug problem. Internationally, we need to be consistent – and attack the problem with children at a young age through education to cut the demand.

What are your own plans for the future?

We’re very interested in the European market. We’ve looked at some sites in London, for our first laboratory there. We’re very excited about the potential of doing that. We want to get together with the thought leaders in London and talk to them about what they need, what they want and what they’re going to get out of a more personalised laboratory. Let’s see if we can implement it together. Our goal is to put together a great policy to help people get well.

We spend a lot of time in the recovery business. We see a lot of people who have been on the really bad side of things and have still been able to get them completely back. I saw somebody who had been a life-long drug addict for 55 or 56 years make a complete recovery, so there is hope. It doesn’t matter what age people are, we don’t give up on anybody. There is always hope and that’s what we do. We work with people who want to get clean and help them to do so.

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