Reimagining Toxicology Screening In Substance Use Disorder Treatment: A Feasibility Study of a Nonprofit Laboratory Model

Background and Purpose

Toxicology screening is a standard component of the substance use disorder treatment continuum; however, unethical practices related to over-testing and fraud create financially and legally burdensome consequences that disproportionately impact underinsured and criminal justice system-involved populations. The limited research available indicates that poor handling of toxicology screening negatively impacts treatment outcomes but does not suggest structural alternatives to current screening systems.

This paper seeks to address that gap by examining the feasibility of non-profit micro labs as an alternative approach for toxicology screening to reduce systemic inequities. It explores the community's need for toxicology screening services that are responsive to the disproportionate harm created by current systems. Secondly, it examines the structural, regulatory, and financial factors that would influence the feasibility of a non-profit micro-lab model.

Methods

The exploratory feasibility study used a mixed-methods design that included secondary dataset analysis, policy analysis, and market review. The data set used for the secondary analysis was the SAMHSA TEDS-A 2023 (Treatment Episode Data Set-Admissions), which provided demographic information on individuals who sought substance use treatment. A descriptive analysis was conducted to determine the prevalence of legally involved and underinsured populations in the target area (New York). Policy analysis reviewed regulatory documents from OSHA (Occupational Safety and Health Administration), NIOSH (National Institute for Occupational Safety and Health), ISO 15189 (International Organization for Standardization), and 42 CFR Part 493 (Code of Federal Regulations) to assess the regulatory and accreditation requirements for toxicology screening laboratory services. Lastly, a market analysis was conducted by compiling cost estimates from laboratory equipment vendors to determine laboratory start-up costs and cost reduction strategies.

Findings

Secondary data analysis identified there were 56,000 legally mandated, uninsured, or underinsured individuals enrolled in substance use disorder treatment in New York during the 2023 SAHMSA TEDS-A collection period, indicating that there is a significant population who carries a heightened vulnerability to misuse and fraud issues in toxicology screening practices. Policy analysis suggests regulatory feasibility for a micro-lab structure that maintains minimal staffing to provide focused toxicology screening services. Market analysis suggests financial feasibility for a small-scale lab, revealing important cost-reduction strategies that may be especially pertinent for non-profit models.

Conclusions and Implications

Findings indicate the financial and regulatory feasibility of a micro-lab model, which could be a viable alternative to current systems and limit incentive-driven over-testing. Findings also suggest that, given the prevalence of vulnerable populations, the target area would benefit from developing alternative toxicology screening systems.

These findings can also help create systems change within the substance use treatment community and the broader research community. Organizations providing substance use treatment can use this study to begin identifying grant opportunities and interdisciplinary collaboration approaches to take the next steps in developing and implementing the model. The research community can use this study as a call to action to engage in more focused research to better understand the harm caused by current toxicology screening processes.