“Having the ability to identify at-risk compounds helps to keep those I care for safe, and in this case, led to a significantly improved clinical outcome for this individual.”

Leveraging High-Complexity Toxicology Testing to Inform Clinical Decisions in Primary Care

Practicing as a Primary Care provider requires significant skill as practitioners in this space are often faced with the challenge of managing multimorbid individuals with a wide variety of conditions. Kate Mariani, a long-time Physician Assistant with Family Medicine Specialists in Illinois, cares for individuals with conditions ranging from acute injuries to long term management of hypertension or diabetes. Within her practice, some individuals are treated for conditions such as chronic non-cancer pain, generalized anxiety disorder, major depressive disorder, and attention-deficit/hyperactivity disorder. Within this population, definitive testing can be of great value for assessing medication adherence to prescribed pharmacotherapy, but also for evaluating use of substances that may put individuals at risk for adverse events. “I use a multi-faceted approach when evaluating prescription and non-prescription substance use in my practice. While patient assessment and use of controlled substance database reports provide great information, inclusion of definitive test results to supplement care is key to treatment.”

The results below were reported based on testing of a specimen submitted by a female in her forties that has been under the care of Kate for 10-12 years. Kate has managed this individual’s generalized anxiety for many years. This individual, at times, has struggled with coping with her condition, but has always been forthcoming throughout treatment. Kate has often counseled this individual regarding the risks of use of non-prescribed substances, but the results of a recent urine test revealed something unexpected to both patient and provider.

“I frequently counseled this individual regarding the risks for use of substances beyond what I was prescribing. Although we had a great relationship, and she was honest with me throughout the duration of her care, identification of the designer benzodiazepine, 8-aminoclonazolam, allowed me to break through and educate in a way that I had not before.”

Upon identification of a designer benzodiazepine in this individual’s urine specimen, Kate leveraged the results to not only strengthen her own clinical decisions, but to really drive home the risk of non-prescribed substance use.

“The individual in my care was completely unaware that she had received a drug that was substituted with a designer benzodiazepine. This opened the door for a greater understanding of the risks of her substance use, and eventually led to her seeking out rehabilitative care. Having the ability to identify at-risk compounds helps to keep those I care for safe, and in this case, led to a significantly improved clinical outcome for this individual.”

Kate Mariani, Physician Assistant
Family Medicine Specialists is a full service family physician group, caring for patients through
all stages of life.