New recommendations address evolving drug landscape and advancing testing technologies since original 2003 guidance.
The Association for Diagnostics & Laboratory Medicine (ADLM) has released updated expert guidance on urine drug testing for patients in the emergency department, marking the organization’s first revision of its drug testing recommendations since 2003.
The updated guidance addresses significant changes in both drug use patterns and testing technology that have emerged over the past two decades. Since 2013, synthetic opioids, including fentanyl, have increasingly dominated the illegal drug supply, while new designer recreational drugs are created annually to circumvent existing drug laws.
Conversely, the use of certain drugs such as tricyclic antidepressants has declined since the early 2000s, making routine testing for these substances less clinically relevant, according to the guidance.
Drug testing plays a critical role in emergency department care for patients presenting with signs of drug overdose or altered mental status. The guidance notes that positive drug test results in pediatric patients with altered mental status can prevent unnecessary MRI procedures and alert healthcare providers to involve child protective services when appropriate.
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Alongside evolving drug use patterns, testing technology has advanced significantly since the original guidance. Immunoassays, the standard drug testing method, have improved in performance. Additionally, more healthcare institutions now have access to mass spectrometry, which can detect drugs in cases where immunoassays cannot.
With all of these factors in mind, a group of experts formed by ADLM’s Academy of Diagnostics & Laboratory Medicine has updated the association’s 2003 guidance. Major recommendations from the document include the following:
- Laboratory experts and emergency department clinicians should collaborate to ensure that drug tests are used appropriately for both pediatric and adult patients. In particular, labs should educate emergency department and other specialty providers about the performance and limitations of drug tests and should be available to assist with test interpretation.
- The clinical laboratory and emergency department should periodically review their institution’s drug test menu and protocols and update them to reflect local drug use patterns. The lab and emergency department should also make sure that their test menu only includes tests whose results will actually guide patient management.
- Although mass spectrometry is more costly and complex than immunoassays, the clinical laboratory and emergency department should consider using this method for special populations such as pediatric patients and in cases where an immunoassay would be insufficient and the test result would inform the patient’s care.
“Regardless of the method(s) offered, all laboratories should collaborate with [emergency department] leadership…to ensure test menus are up to date and reasonable for the patient population,” write the document authors Drs Christine LH Snozek, Matthew D Krasowski, Jennifer M Colby, Kamisha L Johnson-Davis, Rebecca E Bruccoleri, and Stacy E Melanson.
The guidance also stresses the importance of ongoing education and communication between laboratories and emergency departments regarding assay performance and limitations.
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