Definitive LC-MS/MS Drug Monitoring Impacts Substance-use Treatment Planning and Patient Outcomes: A Brief Report

Abstract

Clinical drug monitoring has an increasingly important role in the treatment of substance use disorders. Through semistructured interviews, we asked substance-use counselors about the clinical impact of drug tests on patients' treatment planning and outcomes. This study was conducted around the time of a facility-wide switch to a laboratory utilizing definitive liquid chromatography with tandem mass spectrometry from a laboratory that had utilized the less-sensitive, presumptive immunoassay-based drug-testing methodology. Twelve counselors volunteered to be interviewed, and each counselor chose 2 patients to discuss. Counselors reported that the facility-wide switch to definitive drug testing revealed some patients with newly identified relapses and substance use. They also reported that, as a result of the new information provided by definitive liquid chromatography with tandem mass spectrometry monitoring, 75% of the patients they discussed had a change made to their treatment plan, 79% were provided enhanced education, and 63% had an increase in their treatment intensity. Counselors also reported that 58% of these patients reduced their illicit drug and nonmedical prescription medication use as a result of treatment changes associated with the newly implemented definitive testing. Improvements in therapeutic relationships and honesty were also reported. These preliminary data are consistent with previous data and guidelines, suggesting that the results of definitive drug monitoring inform clinical decision-making and can help clinicians enhance treatment outcomes.

Polydrug use among patients on methadone medication treatment: Evidence from urine drug testing to inform patient safety

“…As noted, some have voiced concerns that UDT can be used in a manner that can be stigmatizing and worse, punitive, in a variety of populations [17]. However, education and communication training about how to incorporate drug test results indicative of polydrug use into treatment planning in a non‐stigmatizing fashion might prove helpful [18, 19]. When used holistically, UDT could help guide conversations about the drug supply and promotes safer practices (such as naloxone distribution and fentanyl test strips).…”

“…As noted, some have voiced concerns that UDT can be used in a manner that can be stigmatizing and worse, punitive, in a variety of populations [17]. However, education and communication training about how to incorporate drug test results indicative of polydrug use into treatment planning in a non-stigmatizing fashion might prove helpful [18,19].…”

Definitive urine drug test findings in patients prescribed opioids for pain from a large national database

“…Using UDT as part of monitoring has been shown in other populations to improve the patient-clinician therapeutic relationship. 30 Our study population may represent a sample of patients who were more consistently monitored with UDT than other populations of patients with pain, potentially contributing to improved medication-taking behavior. Additionally, we only chose to examine four illicit substances known to contribute to drug overdose deaths; other drugs known to increase the likelihood of overdose, including benzodiazepines and alcohol as well as other central nervous system depressants, may play an important role in unintended overdose fatalities in a patient prescribed opioid therapy.…”

Does the Perceived Accuracy of Urine Drug Testing Impact Clinical Decision-Making?

“…[1][2][3] Monitoring patients with UDT during addiction treatment can encourage patients to follow an established treatment plan and can assist providers in determining whether the treatment plan should be modified. 4,5 Test results also enable clinicians to determine whether an individual is at risk for, or has relapsed, or if a court-mandated offender has violated the conditions of his or her probation. Drug testing can be performed using various analytical methods, including immunoassay (IA; also referred to as "screening" or "presumptive" testing 1 ) and more sophisticated mass spectrometry testing (e.g., liquid chromatography-tandem mass spectrometry or LC-MS/MS; also referred to as "definitive" or "confirmatory" testing 1 ).…”