B-326 Home Collected Oral Fluid Specimens Are a Viable Option for Telemedicine Based Toxicology Testing
Authors: Canner J P , Moonschi F H 
Published: September 2023

Abstract

Background
A standard treatment for Substance Use Disorder (SUD) is Medication Assisted Therapy (MAT) consisting of a buprenorphine-naloxone combination medication. Typically, a urine specimen is collected during the in-office visit for the patient to receive MAT. Urine drug testing (UDT) ensures compliance and adherence with the treatment protocol and is often mandated for MAT. However, access to in-office visits and the ability to provide a specimen for UDT can be problematic for individuals undergoing MAT for SUD due to factors such as limited access to reliable transportation or distance to facilities. The COVID-19 pandemic has eased restrictions around telemedicine, including for the administration of MAT. Telemedicine can be a valuable tool to provide greater access to MAT for individuals by removing transportation barriers to treatment. Gravity Diagnostics partnered with various facilities to provide a telemedicine observed oral fluid toxicology (OFT) collection process. To understand if telemedicine OFT could provide the same information as in-office collected specimens, we compared telemedicine OFT to in-office OFT specimens and for one facility telemedicine-OFT to in-office UDT.

Methods
Gravity Diagnostics provides OFT through LC-MS/MS quantitative testing for over 72 analytes. Using a deidentified data set from our LIS, we identified OFT specimens that were collected either in-office or through telemedicine during a 6 month period. The ability to determine the effectiveness of telemedicine OFT was measured by examining the unexpected positivity rate of 72 analytes when compared to in-office OFT. We used 2-way ANOVA to determine if the detection rate of unexpected analytes between two collection methods were significantly different. Additionally, we identified a facility that conducted in-office UDT and telemedicine OFT on the same patient population. These data were compared in a similar manner with the unexpected positivity rate for 47 analytes subjected to 2-way ANOVA.

Results
When the unexpected detection rates between the in-office and telemedicine OFT were compared with a 2-way ANOVA, a P-value of 0.554 was found between the collection methods. This result indicated that the detection rates of unexpected analytes between the in-office and telemedicine collections were not significantly different. Similarly, when the unexpected detection rates between the UDT and the telemedicine-OFT were compared, a P-value of 0.391 was found between the collection methods. This result indicated that the detection rates between in office UDT and telemedicine OFT were not significantly different when compared within the same patient population.

Conclusion
Our data showed that telemedicine-OFT are comparable to in-office OFT for the detection of unexpected positive analytes. In addition, when the same patient population was tested by either telemedicine-OFT or in-office UDT, no significant difference in detection rates of unexpected positives is observed. Therefore, we are confident that we can utilize telemedicine-OFT to provide greater access to health care for patients undergoing MAT for SUD.