How affordable toxicology, testing fight the drug epidemic
October 26, 2016
By Leon Reyfman
Opioid abuse is a serious public health issue. In 2014, more than 28,000 people died from opioid overdose, and at least half of those deaths involved a prescription opioid. Many more became addicted to prescription and illegal opioids. Heroin-related deaths have also increased sharply, more than tripling since 2010. In response, communities across the country are seeking new prevention and treatment methods. At the same time, payers, health care providers and policymakers are focusing on insurance coverage that would enable drug tests to be more affordable and widely available.
A key part of this solution is reliance on state-of-the-art labs that are designed to provide the highest quality of testing, expedient delivery of results and superior customer service. In particular, small labs tend to be more responsive about scheduling opportunities, deliver faster turnaround of test results and offer more competitive pricing than large labs.
The genetics of addiction
Addiction is estimated to be about 40 percent to 60 percent inherited, meaning that genetics are likely to account for about half of a person’s risk. Other factors involve environmental, social and cultural experiences, such as being exposed to peer pressure, individual coping skills, chronic pain, depression and the properties of the drugs themselves. Fortunately, the latest generation of gene sequencing instruments and molecular analyzers are less expensive, faster and more automated than ever, making it easier for smaller labs to offer sophisticated genetic tests.
Pain management and toxicology
Health care providers continue to struggle to find the best way to treat patients who suffer from chronic pain. Their dilemma stems from the potential risks involved with long-term treatment, such as the development of drug tolerance, increased pain sensitivity and addiction. Research has shown that maintaining steady levels of opioids contributes to pain relief, but patients metabolize pain medications at different rates. Slow metabolizers of opioids may sustain dangerously high levels of opioids in the body, resulting in adverse events. Personalized knowledge of a patient’s metabolism patterns may assist in dosing.
A number of physicians opt to initially screen with basic drug confirmation tests, but toxicology services are superior for monitoring chronic pain patients. A toxicology lab can provide more accurate results and more valuable insights. The most effective approach to drug testing includes greater use of random testing of urine, blood, saliva, hair, nails, sweat and breath when those matrices match the intended assessment process.
Physicians and medical practices should look for labs that rely on medical research, quality and expedient testing that goes beyond current standards of clinical toxicology, providing the highest toxicology and clinical testing in the industry, including drug testing of urine and oral fluids, and pharmacogenetics for personalized prescribing.
The benefits of pharmacogenomics
Pharmacogenomics testing is used to identify how genes affect a patient’s response to medication. Genomic differences influence the efficacy of medication and can be the source of serious drug side effects and increase the risk of drug-to-drug interactions. Pharmacogenetic testing is the alternative to one-size-fits-all drug prescribing, which can lead to potentially serious side effects, treatment failure and poor patient compliance.
Pharmacogenetic testing can also indicate which patients will be likely to experience adverse events with particular drugs, and is the cornerstone of tailoring health care to each person’s unique genetic makeup. For pain physicians, pharmacogenetic test results can assist in demonstrating that a particular patient requires a higher medication dose to experience pain relief. For example, typical doses may not control pain for high metabolizers, who run the risk of being labeled abusers. The goal is to help physicians select the most optimal treatment regimen for each particular patient just by doing a simple buccal swab. Personalized pain management determines the most effective and individualized maximum desirable analgesic relief and minimal undesirable adverse effects. It’s about pinpointing the right drug, at the right dose, for the right patient.
Some of the country’s top small labs are at the forefront of innovation for toxicology testing and implementing more effective outreach, engagement, treatment and coordination with the health and mental health systems and social supports. Accessible, reliable and rapid testing enables doctors, caregivers and patients to get the information necessary to achieve the highest quality care and outcomes.
About the author: Leon Reyfman, M.D., FIPP, RpH, and CEO of Advanced Clinical Laboratory Solutions is board certified in anesthesiology and pain management. He serves as director of interventional pain medicine at Long Island College Hospital and is assistant clinical professor of anesthesiology at SUNY Downstate Medical School.
Opioid abuse is a serious public health issue. In 2014, more than 28,000 people died from opioid overdose, and at least half of those deaths involved a prescription opioid. Many more became addicted to prescription and illegal opioids. Heroin-related deaths have also increased sharply, more than tripling since 2010. In response, communities across the country are seeking new prevention and treatment methods. At the same time, payers, health care providers and policymakers are focusing on insurance coverage that would enable drug tests to be more affordable and widely available.
A key part of this solution is reliance on state-of-the-art labs that are designed to provide the highest quality of testing, expedient delivery of results and superior customer service. In particular, small labs tend to be more responsive about scheduling opportunities, deliver faster turnaround of test results and offer more competitive pricing than large labs.
The genetics of addiction
Addiction is estimated to be about 40 percent to 60 percent inherited, meaning that genetics are likely to account for about half of a person’s risk. Other factors involve environmental, social and cultural experiences, such as being exposed to peer pressure, individual coping skills, chronic pain, depression and the properties of the drugs themselves. Fortunately, the latest generation of gene sequencing instruments and molecular analyzers are less expensive, faster and more automated than ever, making it easier for smaller labs to offer sophisticated genetic tests.
Pain management and toxicology
Health care providers continue to struggle to find the best way to treat patients who suffer from chronic pain. Their dilemma stems from the potential risks involved with long-term treatment, such as the development of drug tolerance, increased pain sensitivity and addiction. Research has shown that maintaining steady levels of opioids contributes to pain relief, but patients metabolize pain medications at different rates. Slow metabolizers of opioids may sustain dangerously high levels of opioids in the body, resulting in adverse events. Personalized knowledge of a patient’s metabolism patterns may assist in dosing.
A number of physicians opt to initially screen with basic drug confirmation tests, but toxicology services are superior for monitoring chronic pain patients. A toxicology lab can provide more accurate results and more valuable insights. The most effective approach to drug testing includes greater use of random testing of urine, blood, saliva, hair, nails, sweat and breath when those matrices match the intended assessment process.
Physicians and medical practices should look for labs that rely on medical research, quality and expedient testing that goes beyond current standards of clinical toxicology, providing the highest toxicology and clinical testing in the industry, including drug testing of urine and oral fluids, and pharmacogenetics for personalized prescribing.
The benefits of pharmacogenomics
Pharmacogenomics testing is used to identify how genes affect a patient’s response to medication. Genomic differences influence the efficacy of medication and can be the source of serious drug side effects and increase the risk of drug-to-drug interactions. Pharmacogenetic testing is the alternative to one-size-fits-all drug prescribing, which can lead to potentially serious side effects, treatment failure and poor patient compliance.
Pharmacogenetic testing can also indicate which patients will be likely to experience adverse events with particular drugs, and is the cornerstone of tailoring health care to each person’s unique genetic makeup. For pain physicians, pharmacogenetic test results can assist in demonstrating that a particular patient requires a higher medication dose to experience pain relief. For example, typical doses may not control pain for high metabolizers, who run the risk of being labeled abusers. The goal is to help physicians select the most optimal treatment regimen for each particular patient just by doing a simple buccal swab. Personalized pain management determines the most effective and individualized maximum desirable analgesic relief and minimal undesirable adverse effects. It’s about pinpointing the right drug, at the right dose, for the right patient.
Some of the country’s top small labs are at the forefront of innovation for toxicology testing and implementing more effective outreach, engagement, treatment and coordination with the health and mental health systems and social supports. Accessible, reliable and rapid testing enables doctors, caregivers and patients to get the information necessary to achieve the highest quality care and outcomes.
About the author: Leon Reyfman, M.D., FIPP, RpH, and CEO of Advanced Clinical Laboratory Solutions is board certified in anesthesiology and pain management. He serves as director of interventional pain medicine at Long Island College Hospital and is assistant clinical professor of anesthesiology at SUNY Downstate Medical School.