Laboratorians seeking insight on the opioid crisis and management of chronic pain should sign up for AACC’s online conference, “The Laboratory’s Role in Monitoring for Pain Management,” on June 15.

Opioid and non-opioid painkillers are used commonly to treat chronic pain, which has gained prominence as a significant health issue. The high volume of opioid prescriptions has led to misuse, abuse, and adverse health outcomes in patients, including unintentional opioid deaths. As CLN Stat has reported, the Centers for Disease Control and Prevention released a new guideline in response to these safety concerns.

AACC’s conference plans to address opioid use and clinical perspectives on managing chronic pain, along with these other timely issues:

  1. Analytical methods (mass spectrometry, immunoassay) and various matrices (urine, oral fluid) used in toxicology, along with a few selected case studies;
  2. Medical marijuana and pain management;
  3. Testing for drugs in the unintended patient, the neonate; and 4. Reimbursement for both laboratory testing and consultative services as they apply to drug monitoring for pain management.

According to the conference program co-chairs, this is an opportune time for laboratorians to look at testing issues around pain management. Laboratories may provide necessary testing services, yet “clinicians aren’t always aware of which tests are appropriate to order or the limitations of the testing methods, and may not be comfortable with interpreting complex toxicology results that may determine the treatment of their patients,” Barbarajean Magnani, MD, PhD, and Nicholas Heger, PhD, of Tufts Medical Center, told CLN Stat.

False or unexpected positives and negatives are a big issue for labs right now. “Laboratorians are usually made aware of these concerns when a clinician calls regarding a result that doesn’t make sense,” the co-chairs stated. Interfering substances or cross-reactivity with non-target prescription or non-prescription drugs may lead to a false positive result, whereas non-compliance or lack of cross-reactivity of the specific opioid with an opiates class assay or even adulteration of the specimen may cause a false or unexpected negative result.

Doctors often rely on urine drug testing to assess patient compliance and detect any potential aberrant drug behaviors. “However, the conclusions drawn from urine drug testing are directly influenced by the analytical methods that are used and with the understanding that the laboratory cannot determine if the patient is taking the medication exactly as prescribed,” Magnani and Heger said.

Clinicians need to know what a lab’s assays will and won’t detect, any possible interferences producing false positive results, or lack of assay specificity that may produce a negative result. According to the conference’s co-chairs, this is a particular concern for class-based immunoassay tests such as opiates, benzodiazepines, and amphetamines.

With respect to opioids, CDC’s new guideline recommends starting with the lowest possible effective doses. “If the immunoassay used by the laboratory is relatively insensitive to a particular opioid prescribed to a patient, a negative result does not necessarily indicate noncompliance. This is just one example of where laboratorians can provide added value by connecting with clinicians to explain testing limitations, recommend more specific tests and methods, and aid in interpreting complex laboratory results,” according to Magnani and Heger.

Register online to attend this important conference and earn 5.0 ACCENT credits and 5.0 CME credits.