Getting beyond the ‘gotcha’ syndrome

The director of clinical addiction research and education at San Diego-based Millennium Laboratories stands among those who would like to encourage a paradigm shift in how addiction treatment facility professionals view the role of drug testing in their programs.

Steven Passik, PhD, who joined the clinical diagnostic company at the end of 2012, believes drug testing can serve as a viable clinical treatment tool if treatment facilities can get beyond the notion that the technology exists simply to confirm the need for sanction against a patient (what he calls the emphasis on “gotcha!”).

“I’m seeing an evolution in the use of testing, from simply forensic to a more clinical model that is supplying information for patient monitoring without dire consequences,” says Passik, a psychologist with a long-term academic background who also is serving as principal investigator for the Millennium Research Institute.

Millennium offers drug detection and medication monitoring services, and like many companies in the fast-growing drug testing industry has staked out a significant presence in the area of pain management. The nonprofit Millennium Research Institute has prioritized education and research efforts to advance the assessment and management of chronic pain.

Testing as therapy
“We need to have the view evolve toward one that says testing is therapy in and of itself,” says Passik, who adds that he is working on an academic paper geared to enhance addiction counselor education on testing issues.

Individuals with an addiction history have shown a relative inability to plan and to self-monitor, as well as to anticipate the true consequences of their everyday actions, Passik says. Drug testing in this regard can do more than simply monitor—it can give patients important feedback about their behavior over the course of treatment, he says.

Passik equates the situation to what has been learned over the years in research about diet success and failure. Common wisdom used to hold that individuals on a diet shouldn’t weigh themselves too frequently, in part because the results might discourage them. But when European researchers compared weight-loss results for patients who weighed themselves only once a week and those who weighed themselves twice a day, the individuals with the more frequent weigh-ins actually showed the best weight-loss results, says Passik.

While Passik considers himself a strong advocate for a shift in mindset in the treatment community about how to use the results of drug testing, he says that does not translate to Millennium’s taking an aggressive role in advising individual clients on how they should respond to specific test results. "What they do with the results is up to them,” he says with regard to treatment facilities.

Yet he tries to emphasize the potential for cost savings related to detecting relapse sooner, and also reiterates the expectation of relapse in a chronic disease. “If someone is having a relapse, why would you penalize that person for exhibiting the nature of the disease?” Passik says.

Other priorities   
Millennium collects quarterly data on test results and uses the information to give facility clients feedback on false negatives and positives in office-based testing, thus making the case for confirmatory testing in a laboratory. Millennium uses Liquid Chromotography (LC) technology in its laboratory testing protocols.

Recent data from Millennium reported, for example, that benzodiazepine use had been missed in about one-third of office-based tests. False negatives were even slightly higher than that, at around 44%, for office-based testing for cocaine use.

“Some treatment professionals have no idea about false negatives, as well as how many substances can be tested for,” says Passik.

Another area of emphasis at Millennium and other drug testing companies involves keeping test panels updated to reflect new and anticipated demographic trends in substance use. The company announced last summer that it had developed a new urine test designed to detect the presence of Kratom, a tropical plant native to Southeast Asia that had appeared on the Drug Enforcement Administration’s (DEA’s) list of drugs of concern because of dangers of addiction and psychological disturbances.

“Kratom, as well as emerging illegal substances such as bath salts and Spice, which were recently added to our test menu, pose a major challenge for clinicians and addiction treatment centers,” Millennium president Howard Appel said in a statement at the time of the announcement last August.