The opioid task force of the National Independent Laboratory Association (NILA), St. Louis, Mo, has released a white paper highlighting the essential role toxicology laboratories play in managing the opioid crisis in the United States.1

The drug addiction and opioid overdose epidemics have been steadily growing in the United States, with no signs of reversing course. According to data compiled by the Centers for Disease Control and Prevention, nearly 72,000 deaths occurred as a result of overdose in 2017. While the deaths linked to prescribed opioids have increased, the majority of deaths caused by opioid overdose point to illicitly manufactured chemicals, such as fentanyl and its derivatives, and extremely potent synthetic substances, such as carfentanil and U-47700. In addition to opioids, other novel psychoactive substances, such as synthetic cannabinoids, can cause severe illness, health problems, and death. Toxicology laboratories that provide high-complexity drug testing using mass spectrometry provide critical data that is essential to healthcare providers as well as to public health and law enforcement agencies.

Photo BirenbaumMark_cropped

Mark Birenbaum, NILA.

“High-complexity drug testing performed in a CLIA-certified toxicology laboratory is an essential piece of addressing the opioid crisis,” says Mark Birenbaum, administrator of NILA. “While point-of-care diagnostics play an important role, they are prone to higher incidences of false positives and false negatives. High-complexity testing performed in toxicology laboratories produces qualitative and quantitative results, and is performed and interpreted by highly trained laboratory staff.”

According to NILA’s white paper, laboratories that perform high-complexity drug testing stay ahead of the emerging designer drug landscape and provide critical information to healthcare providers and public health agencies.

The opioid epidemic is a complex problem with no single solution and little objective data to support clinical decisionmaking and treatment protocols. Strategic partnerships whereby toxicology laboratories provide objective data must be formed to develop best practices, nationwide policies, and innovative medical management solutions.

NILA’s white paper issues a call to action to:

  • Educate partners on the role of toxicology laboratory testing in combating the opioid epidemic.
  • Ensure adequate reimbursement for high-complexity testing performed in CLIA-certified toxicology laboratories to preserve the complex laboratory infrastructure essential to addressing the opioid epidemic.
  • Enable data sharing by gathering stakeholders to participate in a formal discovery process to determine the core elements of a data sharing strategy.
  • Foster collaboration to collectively address the addiction and opioid epidemic.

By working toward these goals and partnering across a diverse set of stakeholders, high-complexity toxicology laboratories can provide key data elements to help develop coordinated and multifaceted strategies to combat and solve the opioid crisis.

NILA members are independent community and regional clinical laboratories working with physician practices, hospitals, outpatient care settings, skilled nursing facilities, and home health patients to provide essential clinical laboratory services to Medicare beneficiaries, particularly those in underserved communities and hard-to-reach care settings.

To learn more, visit NILA.


  1. Curbing Drug Addiction and the Opioid Crisis: The Role of Toxicology Laboratories in Diagnosis, Treatment, and Prevention. St Louis: National Independent Laboratory Association, 2018. Available at: Accessed October 15, 2018.