According to the National Survey on Drug Use and Health, 2 million people misused prescription opioids for the first time in 2018, and more than 130 people died each day in 2019 from opioid-related drug overdoses. Drug abuse is often contextualized with the criminal justice system, rather than the mental health system.

In the session “The Role of the Clinical Laboratory in Substance use Treatment and Research,” the speakers address substance abuse in the context of public health and how laboratorians play a key role in harm reduction and addiction treatment programs.

Ju Park, PhD, covers public health strategies for the opioid crisis broadly, highlighting the importance of harm reduction as a way to mitigate substance abuse. The main principle of harm reduction is avoiding the stigma associated with drug use, as well as a focus on reducing health risks rather than achieving abstinence.

Park notes that drug testing is not limited to testing biological specimens, such as urine or oral fluid, while a person is undergoing treatment. It can also extend to testing a substance to confirm the exact composition of the compound and raising public awareness of associated risks.

People can unknowingly use substances that are laced with other compounds or are more potent than initially perceived, leading to bad outcomes such as drug overdose. Harm reduction strategies include respecting a person’s decisions while also providing information, such as compound purity, to keep them safe, rather than relying on punitive measures such as imprisonment or coerced detoxification.

William Clarke, PhD, offers insights based on some of the questions he gets frequently from addiction treatment providers, and he explains some of the lab tools used to assist in answering those questions. In most cases, his lab uses enzyme immunoassays and liquid or gas chromatography mass spectrometry to analyze biological specimens to ensure compliance, divergence, and/or abuse of illegal substances.

Clarke also shares his experience with detecting drugs using untargeted high-resolution mass spectrometry. The goal of this research is to identify new substances as they enter the illicit drug market, rather than wait to gather data from postmortem analysis.

The last portion of the session explores the role of lab testing in preventing opioid use disorder (OUD). Keri Donaldson, MD, highlights the importance of informed decision-making in terms of a provider’s obligations and a patient’s rights. While clinicians assess risk for opioid abuse prior to prescribing opioids for short-term or long term- pain management, often these tools are too subjective, Donaldson says.

Donaldson describes an objective assessment tool that is able to determine the likelihood of developing OUD in opioid naïve patients for whom clinicians are considering short-duration opioid treatment. He discusses research that showed how a genetic panel can flag patients who are 20 times more likely to develop OUD compared to those who don’t have the genetic mutations. Even if clinicians prescribe opioids to patients who are likely to develop OUD, results of this test can help them pinpoint whom they should monitor more frequently.

Given the risk differential and objectivity in risk assessment,. Donaldson hopes more clinicians use the test prior to prescribing short-term opioids to opioid naïve patients. By the end of the session, the speakers hope that attendees will view substance abuse as more than physical dependency and understand both the importance of informed decision-making and the clinical lab’s unique role in the care of these patients.