The American Society of Addiction Medicine (ASAM) is now accepting public comment on a new drug testing appropriateness document it is writing to provide guidance on the use of testing in the continuum of care.
“There’s always been some question and concern about when you use certain kinds of tests, how you use them, and how frequently they should be used,” says Margaret Jarvis, MD, DFASAM, a member of the ASAM board of directors and chair of its Quality Improvement Council (QIC) overseeing the project. “With the explosion of opiate use, there has been some really unfortunate, untoward treatment going on that is less than effective and has caused a lot of problems for a lot of people.”
Specifically, the creation of a drug testing appropriateness document will benefit:
- Insurers seeking guidance on the types of drug tests it should cover (Jarvis notes that less reputable facilities have profited “by doing boatloads of essentially unnecessary drug testing and charging insurance for it, sometimes to the tune of a couple thousand dollars per patient, per week.”);
- Investigators looking for fraudulent behaviors on the part of treatment programs; and
- Those who are looking to set up new treatment programs but are unsure of when to use expensive testing options.
ASAM previously published a white paper on drug testing in 2013 that described methodologies and their limits. The document currently in development breaks new ground by covering principles and process of drug testing in addiction treatment, key elements of a testing program, biological matrices, settings and levels of care, special populations and areas for further research.
The council is working in conjunction with a vendor, the Institute for Research, Education and Training in Addictions (IRETA), to draft the document. The QIC will accept public comments on the draft until 5 p.m. on Feb. 28, after which Jarvis and another member of the QIC will collaborate with IRETA to reconcile feedback with the initial draft and implement changes as needed.
The strict methodology of using a structured census process that combines scientific evidence with clinical knowledge is designed to limit bias, Jarvis tells Addiction Professional.
“It’s easy to sit three people in a room and create a document, but if you do that, you end up with significant bias from those three people,” Jarvis says. “A lot of what’s out there has been that way. It’s not that those are necessarily invalid or bad, but you need to keep that in mind if you’re using them. Part of what we’ve worked really hard to do is to make this something that is as free of bias as is possible given that we don’t have randomized, controlled trials to guide it.”
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