Revamped Opioid Testing Process at UH Boosts Safety and Convenience for Patients and Providers, Garners International Acclaim

UH Clinical Update | August 2023

A new and simplified urine testing process for opioids and benzodiazepines, developed at University Hospitals in response to the ongoing opioid epidemic in Ohio, has increased patient safety and increased compliance among UH providers. The result is a streamlining of what was previously an onerous and often-confusing testing process, for both providers and patients.

“Clinician compliance with testing guidelines has increased by 35 percent, with our physicians reporting increased confidence in their ability to use drug testing as part of their care for patients who are prescribed controlled substances,” says Jaime Noguez, PhD, Director of Clinical Chemistry and Toxicology at UH Cleveland Medical Center. “Our interventions have facilitated a three-fold increase in the number of patients receiving comprehensive and appropriate controlled substance testing and prescription monitoring, which increases the likelihood of detecting dangerous opioid and benzodiazepine drug combinations or drug diversion.”

Dr. Noguez, along with Christine Schmotzer, MD, Vice Chair of System Pathology Operations and the Linda Sandhaus, MD, and Roland Philip, MD endowed Chair in Pathology and Laboratory Medicine, led the development of the new testing process, with collaboration from the UH Pain Management Institute and clinical and risk management leaders.

A UH Solution

The new testing process was born of necessity in the wake of Ohio’s large and worsening opioid epidemic – one of the most severe in the nation -- plus a need to support UH physicians, Dr. Schmotzer says.

“As we know, physicians who are prescribing opiates and controlled substances are faced with more regulations and more scrutiny around their prescribing practices, which led to increased use of drug testing to assess compliance,” she says. “With that increased use, we needed to provide both education on what to order, and how to interpret it so that we could provide the right test at the right time for the clinician and patient. We felt that by bringing testing in-house, we could control what the whole testing process looks like and tailor it to what our clinicians need.”

As a result, a process that once required perhaps four or five separate lab tests now requires just one.

“We consolidated it into a single orderable test that has multiple tests within it that hits all the questions and actions needed to use drug testing to assess medication compliance and risk,” Dr. Schmotzer says.

UNIVANTS Recognition

The UNIVANTS of Healthcare Excellence award celebrates multidisciplinary collaborations between laboratory medicine and other health specialties that join together to address unmet needs. It was created by Abbott and is advocated worldwide by diverse professional associations across all facets of healthcare.

Key Features of the New Testing Process

In designing the new urine testing process, the UH team balanced the need for simplicity with the imperative to identify an ever-growing number of new substances, Dr. Noguez says.

“There are a lot of new prescription and illicit drugs emerging,” she says. “To address this, we made modifications to our urine drug test panels to ensure that they reflect the drugs being commonly prescribed and abused in our area, that they have intuitive naming so that they are easier to find when physicians place drug test orders, and that they have enhanced features such as specimen integrity checks. We also improved the way test results were displayed in the reports and provided more interpretive information so that physicians could more easily make clinical decisions about whether or not to refill prescriptions. Our goal was to make it as easy as possible for physicians to do the right thing with regard to controlled substance testing.”

Another refinement: A positive screening test for opioids, benzodiazepines and illicit substances now automatically triggers a more comprehensive test to confirm the result. This happens without an additional urine sample from the patient or the need for the provider to order a separate test. This boosts patient safety and operational efficiency, while reducing costs.

 “Since implementing our new changes, we’ve achieved more than 98 percent compliance for the appropriate follow-up of presumptive positive urine drug screens, up from a previous level of 53 percent,” Dr. Schmotzer says. “In addition, this has decreased drug testing costs to patients by 25 percent.”

Model for Others

Dr. Noguez says she hopes the national attention of the UNIVANTS award will encourage other hospital systems around the country to take a close look at what the team at UH has achieved with its new urine testing process for opioids and benzodiazepines.

“Creating an interdisciplinary group that is dynamic, persistent and responsive to evolving needs in order to more deeply incorporate laboratory testing into clinical practice guidelines is adaptable to many processes. It’s not limited to just controlled substance monitoring or even our institution,” she says. “Stepping outside of our respective silos to create a team of key stakeholders from several different disciplines helped us to achieve more than any group could have done independently.”

Dr. Schmotzer also credits UH’s penchant for interdisciplinary collaboration as something to model.

“The concept of working with the clinicians to understand their needs, understand where patient risks are and come up with combined solutions to solve them is a philosophy that is definitely at the heart of UH,” she says. “This is an example of how we can do right by our patients by bringing multiple disciplines together to solve problems.”