The opioid epidemic in the United States is an ongoing public health crisis that has been complicated and exacerbated by the COVID-19 pandemic; national statistics show daily overdose deaths rose by nearly 30% in 2020. As with the pandemic, laboratories play a vital role in fighting the opioid crisis, in areas ranging from emergency departments and hospitals, to random screening services to forensic casework.
Clinical chemistry analyzers can provide fast presumptive results in each of these areas, increasing throughput through automation and the ability to run a panel of multiple tests in one run. Drug-of-abuse assays save time and resources by narrowing the pool of samples that need to undergo more intensive confirmatory mass spectrometry analysis, and can ultimately help save lives by providing doctors and public health officials with the data they need to care for patients and take actions to stem the crisis.
Here are three areas to consider when buying a clinical chemistry analyzer for your lab, whatever your role may be in the battle against opioids and overdoses.
1. What’s on the Test Menu?
Whether your lab does work in emergency diagnostics, pain management compliance, random screening or forensics, one of the first things you’ll want to see when shopping for a clinical chemistry analyzer is the instrument’s test menu. Most product brochures will list the drugs of abuse the instrument can test for, and you will want to read this carefully as not all analyzers come ready to test some commonly abused opioids, like oxycodone, hydrocodone and fentanyl.
If you are consistently running the same 5- to 10-panel drug class test, for routine workplace screening for example, a standard menu including opiates and possibly methadone may suffice; although, some employers like government agencies or operations involving heavy machinery may require an expanded opioid panel including hydrocodone, hydromorphone, oxycodone and oxymorphone. If your work is for a hospital or a drug treatment facility, you will likely benefit from a test menu that includes fentanyl, a growing threat that has contributed to a large number of overdose deaths over the years. Fentanyl testing is also important for forensic work, as it is frequently sold illegally and combined with other illicit drugs like heroin and ecstasy.
Emerging synthetic and semi-synthetic opioids are a continuing problem that pose a challenge for both medical professionals and clinical laboratories attempting to identify drugs of abuse. Just as some manufacturers have expanded their test menu to include fentanyl, newer drugs that aren’t on test menus now may be incorporated later. With this in mind, if your work involves helping to diagnose those who may have taken synthetic drugs, evaluate whether the manufacturer you choose has demonstrated its ability to keep up with new threats and expand its offerings among existing systems. Also consider choosing a system that is amenable to configuration for new reagents, including third-party reagents.
2. Match Your Speed and Throughput Needs
Drug testing can be a demanding process requiring rapid turnaround when life is at stake, or maximum throughput to screen a large volume of samples. Identifying your needs and priorities will help you determine which type of analyzer is a good fit for your lab, and which specifications to look for.
One consideration is the level of automation a system offers and how it will affect your turnaround and throughput. Increased automation of processes like quality control, calibration and sample dilution can remove manual steps and increase both test speed and throughput, and a fully automated system that can be incorporated into continuous processes may be the best choice for large and high-volume labs.
One specification you will always want to compare between instruments is tests per hour, which can range from dozens to thousands. While there are several factors that can impact overall throughput, this metric provides a useful “ballpark” of an instrument’s capacity and limitations. Keep in mind that total listed throughput may include a combination of both photometric and ion-selective potentiometry (ISE) tests. For a smaller, low-volume lab, your main consideration may be which system can provide the most efficiency within the smallest footprint.
Another major factor in choosing the right clinical chemistry analyzer for your lab is sample loading and access; in a dynamic, critical care setting, you’ll want to ensure that your analyzer not only allows for flexible random, continuous access, but also the ability to handle urgent stat samples efficiently and without hassle. For a lab with a more consistent routine workflow, the ability for batch analysis and maximum batch size may be more important aspects to compare between options.
3. Don’t Forget Sample Tracking, Chain-of-custody and Data Reporting
While the main function of your automated analyzer will be to detect the presence of drugs and other chemicals, your test results can become useless if they aren’t properly tracked, secured and reported. Choosing an analyzer that streamlines and automates sample tracking, through connectivity with barcode printers, scanners, laboratory information systems and software, can help prevent errors, improve traceability and ensure compliance with standards for both medical and evidentiary data.
Depending on what type of orders your lab handles, you may want or need to find an analyzer that can be integrated with hospital information systems or court case management software. This level of integration can ensure reports are sent and received quickly and securely, by reducing the need for less secure methods of transmitting reports, like fax and email.
Vendors to Consider:
- Beckman Coulter
- Horiba
- Roche
- Siemens Healthineers
- Thermo Fisher Scientific