Expansion of Oral Fluid Testing of Behavioral Health Drugs

Tuesday, June 16, 2020

Aegis’ oral fluid testing menu has been expanded to allow providers the option to test for many additional medications and/or illicit drugs. The enhancement includes additions of antipsychotics, antidepressants, sedative-hypnotics, anticonvulsants, stimulants, skeletal muscle relaxants, drugs of abuse, and other medications encountered in various behavioral health settings.

Pharmacotherapy plays an important role in mental illness treatment; however, adherence to medication regimens is estimated to be less than 50 percent, with some behavioral health medications thought to be even less.¹ Research has reported patients with schizophrenia are adherent to their medications 10-76% of the time, patients with depression 28-52% of the time, patients with bipolar disorder 20-66% of the time, patients with anxiety disorders 57% of the time, and patients with attention deficit hyperactivity disorder (ADHD) 13-85% of the time.^1,2 Patients with mental illness who are not adherent to their medications have a 77% chance of symptom recurrence after one year and a 90% chance after two years.³ These statistics raise many questions regarding ways to assess patients and improve adherence.

The current restrictions and guidelines on social distancing has caused new financial and emotional stressors for patients, which can lead to increased drug and alcohol use. Decreased contact with social support groups and medical providers can make it more difficult for individuals to adhere to medication regimens. In addition, changes to drug supply and access to care combined with heightened anxiety and depression can lead to increased risk for overdose and/or withdrawal. During this time, maintaining the continuum of care for behavioral health patients is even more essential to support adherence and keep relapse rates from increasing.⁴

The use of telemedicine has increased in recent years, which has helped healthcare professionals provide care to those with mental illness. Telepsychiatry allows direct patient interaction when there are barriers to patients accessing care, such as distance or mental health stigma, usually performed through videoconferencing.⁵ Telemedicine visits for mental health increased from 2,039 in 2010 to 54,175 in 2017, with 1.4% of those visits for individuals with a primary diagnosis of substance use disorder.⁶ Overall, telepsychiatry has been found to have equivalent clinical outcomes to regular face-to-face assessment and treatment, including improved adherence and decreases in hospital admissions, all with a high level of patient satisfaction.^7,8

Medication monitoring is a crucial tool to measure therapy adherence and potential substance misuse. It is imperative to keep this essential tool available to clinicians to assist with care decisions during the COVID-19 pandemic and into the future as telemedicine becomes more widely used. Aegis offers providers the ability to perform oral fluid sample collections remotely during telemedicine appointments to allow for continued patient medication monitoring. Specimens can be collected anytime, anywhere with an observed collection, to reduce the risk of adulteration, and to detect recent drug use.

These enhancements will increase the utility of oral fluid medication adherence by allowing testing for a wider variety of medications used to treat various mental health conditions. For those who wish to learn further about the foundations of oral fluid testing, a concise review is available in our clinical reference guide section on Oral Fluid Testing.

Please call our clinical team at 1-877-552-3232 if you require additional information.

NOTICE: The information above is intended as a resource for health care providers. Providers should use their independent medical judgment based on the clinical needs of the patient when making determinations of who to test, what medications to test, testing frequency, and the type of testing to conduct.

  

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References:

1) García S, Martínez-Cengotitabengoa M, López-Zurbano S, Zorrilla I, López P,Vieta E, González-Pinto A. Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients: A Systematic Review. J Clin Psychopharmacol. 2016 Aug;36(4):355-71.  (3)

2) Ahmed R, Aslani P. Attention-deficit/hyperactivity disorder: an update on medication adherence and persistence in children, adolescents, and adults. Expert Rev Pharamcoecon Outcomes Res. 2013; 13(6):791/815. (5)

3) El-Mallakh P, Findlay J. Strategies to improve medication adherence in patients with schizophrenia: the role of support services. Neuropsychiatr Dis Treat. 2015 Apr 16; 11:1077-90. (6)

4) American Society of Addiction Medicine. Challenges for Addiction Treatment Across the Continuum of Care. [webinar]. May 22, 2020. https://nam.edu/event/treating-addiction-across-the-care-continuum-during-covid-19-challenges-and-promising-practices-nam-asam-webinar-series/. Accessed May 22, 2020.

5) Shore JH. What is Telepsychiatry? American Psychiatric Association website. https://www.psychiatry.org/patients-families/what-is-telepsychiatry. Updated January 2017. Accessed May 21, 2020.

6) Huskamp H, Busch A, Souza J, et al. How is telemedicine being used in opioid and other substance use disorder treatment? Health Aff. 2018;37(12):1940-1947.

7) Chakrabarti S. Usefulness of telepsychiatry: a critical evaluation of videoconferencing-based approaches. World J Psychiatry. 2015;5(3):286-304.

8) Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry. 2016;6(2):269-282.