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AACC Guidelines Advocate Use of Mass Spec, Chromatography in Opioid Testing

 NEW YORK (360Dx) – The American Association for Clinical Chemistry recommends the use of mass-spectrometry or chromatography to help combat the opioid epidemic, as part of its guidelines announced today for using clinical lab tests to monitor drug therapy in pain management patients.

The AACC said targeted, definitive tests, such as those based on mass-spectrometry and chromatography are preferable as a frontline test to immunoassays, the current frontline screening method, because immunoassay testing has a higher rate of incorrect response and sometimes only reveals the drug class present in a patient's urine rather that the specific drug.

"Qualitative definitive tests should be used when possible over immunoassay for monitoring use (compliance) to relevant over-the-counter medications, prescribed and non-prescribed drugs, and illicit substances in pain management patients due to their superior sensitivity and specificity," one of the organization's evidence-based recommendations states.

The guidelines acknowledge, however, that immunoassays offer ease-of-use, faster turnaround and lower-cost advantages, and recommend their use in some cases. For example, the guidelines state that "qualitative immunoassay drug testing prior to prescribing controlled substances can be used to identify some illicit drug use and decrease adverse outcomes in pain management patients."

The guidelines also recommend that laboratory experts should partner with clinicians and contribute their specialized knowledge to pain management cases, particularly when aberrant test results are received that need to be interpreted.

"From start to finish, the laboratory drug testing process involves many types of healthcare professionals, from laboratory medicine experts to clinicians, nurses, and pharmacists — all of whom have different areas of expertise and varying levels of familiarity with the tests," said AACC CEO Janet Kreizman. "AACC's guideline aims to give all healthcare providers a solid foundation in urine drug testing best practices, and especially urges healthcare teams to involve laboratory experts in pain management cases."

Other recommendations include best practices for dealing with adulterated specimens, how often patients should undergo drug screening based on their risk for addiction, and which drugs should be tested in routine screening versus only in screening for high-risk patients.

In total, the more-than-100-page document incudes 26 evidence-based recommendations, and seven consensus-based expert opinions in cases where the evidence was limited. A multidisciplinary committee was established to create the guidelines that included clinical laboratory professionals, clinicians practicing in pain management and other healthcare professionals or clinical experts. The experts represented AACC, the AACC Academy, the Clinical Laboratory Standards Institute, which is jointly preparing an expert opinion guideline, the College of American Pathologies, the Evidence-Based Laboratory Medicine Committee, the American Academy of Pain Medicine and the National Institute of Drug Abuse.