Viewpoint: Hospitals should expand drug urinalysis

Standard hospital urine drug analyses do not test for current popular drugs that lead to fatal overdoses, leading to missing diagnoses, according to an opinion piece published Nov. 15 in Scientific American.

The piece was written by Eric Wish, PhD, Amy Billing and Erin Artigiani, who all work at College Park-based University of Maryland's Center for Substance Use, Addiction, and Health Research. They said most hospitals are testing for drugs driving previous drug crises, rather than fentanyl and other synthetic substances used commonly today. Without an opioid-positive urine test, patients may not receive full diagnosis, may not be accepted into treatment programs or have programs covered by insurance. 

In the second quarter of 2022, only 5% of hospitals included fentanyl in their standard drug screen. That number has increased in the last year to roughly 14%, according to a study published in August 2023, but most hospitals remain behind, according to the op-ed. 

The Center for Substance Use, Addiction, and Health Research has been piloting a program called the Emergency Department Drug Surveillance system. It allows hospitals to submit anonymous urine specimens for expanded urinalyses, with no cost to the hospital. The program tracks new patterns in drug use and patient exposure.

"More states should follow the lead taken by California and Maryland and require every hospital to include fentanyl in diagnostic drug screens. New drugs such as xylazine should also be added to urine drug screens in states where they are an identified part of the illicit drug market," the authors said.

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