In 2020, Covid-19 prompted a delay of non-urgent in-person medical care and concurrently exacerbated contributors to substance use disorders, including job loss, economic hardship and mental health issues.

Now, we see the tragic result: drug overdoses took nearly 100,000 lives between April 2020 and April 2021, according to the CDC, sparking new urgency in combatting the drug crisis. A Health Trends report from Quest Diagnostics found that 70% of physicians fear they missed signs of drug misuse during the pandemic, and the large majority fear overdose deaths will continue to rise even as the pandemic subsides.

For individuals with substance use disorders, treatment often begins in the back of an ambulance or Emergency Room. Unless we do a better job at preventing these disorders, our country will never get ahead of the drug crisis, and many more lives will be lost.

One of the only tools physicians have to identify potential drug misuse is clinical drug testing. Many of today’s overdose deaths began with a prescription for an opioid, benzodiazepine or other controlled medication. Screening and monitoring for illicit and prescription drug misuse empowers physicians to intervene early, before dangerous drug combining, substance use, or overdose can occur. Clinical drug testing is a vital tool in combatting the drug crisis. According to the report, 81% of physicians believe clinical drug testing is critical to preventing overdose deaths and 85% report testing gives them confidence they are prescribing safely.

Clinical drug testing often involves two test methods. Typically, a presumptive screening test is done first. If presumptive results indicate reason for concern (i.e., a positive for a nonprescribed sedative), the next step may be a definitive laboratory test to confirm the findings. This definitive test is more sensitive and provides granular information on the drug or drug metabolites present.

For clinical drug testing, presumptive and definitive tests should be performed on the same specimen to confirm test findings and reveal insights into behavior. Same specimen testing also alleviates the potential hardship on patients who lack the time, money and transportation to make repeat office visits. The report found that 60% of physicians are concerned patients may not return to provide a second specimen if presumptive and definitive drug testing take place on specimens collected on different days.

While clinical drug tests are an essential part of care, clear-cut guidelines do not exist on the methods and frequency of testing. Physicians may employ the tests in ways that fail to maximize their clinical value, and some bad actors may over-utilize services for their own financial gain. Health plans seeking to curb inappropriate utilization may inadvertently implement policies that restrict physician access to medically appropriate testing. In the report, 88% of physicians expressed belief that better guidelines would help ensure clinical drug testing is used equitably.

Clinical drug testing gives physicians the ability to uncover potentially problematic drug use and preempt devastating outcomes. Physicians value these tests, but they also want clearer guidelines to optimize their use. Now that government stay-at-home orders have ceased, it is appropriate to reconsider policies that minimized non-essential care, including clinical drug testing. Preserving physician choice and patient access to medically appropriate testing is critical at this perilous time for the nation’s drug crisis and pandemic recovery.

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