Pathologists Confront the Opioid Crisis

Northfield, IL — When someone overdoses on opioids, or any drug, time is of the essence. The right laboratory tests often mean the difference between life and death in a prescription drug overdose. Toxicological analysis identifies the cause of the overdose, and those findings, reviewed by pathologists, are essential in helping select the treatments used to save lives. The College of American Pathologists (CAP) issued a new position statement regarding its role in confronting the nation’s opioid crisis.

“The CAP understands that the opioid epidemic continues to rip apart families and communities across the country,” said R. Bruce Williams, MD, FCAP, CAP president. “A variety of approaches is needed to control this crisis requiring collaboration across the entire health care spectrum.”

“It is imperative that pathologists work together with other clinicians to improve the way opioids are prescribed and monitored to ensure patients have access to safer and more effective chronic pain treatment while also reducing the risk of opioid use disorder, overdose, and death,” Dr. Williams said.

Pathologists oversee and direct the appropriate use of laboratory tests detecting and monitoring the use of opioids for pain and medications used in the treatment of opioid substance use disorder, as well as, the inappropriate use of other prescription, illicit or designer drugs. The CAP urges treating physicians to consult with pathologists and other laboratory professionals about testing, not only for well-known opioids but all other illicit and designer drugs.

“How we monitor, prescribe and treat pain is critical, so it is extremely important to select drug testing methodologies that align with the clinical questions,” said Raouf E. Nakhleh, MD, FCAP, CAP Council on Scientific Affairs chair. “We must also understand testing limitations and work to provide interpretive results, so we can better guide care givers in the treatment of chronic pain and substance abuse.”

The CAP will implement the following:

• Provide education and training for pathologists on tests that monitor drug use/misuse
• Support development of proficiency testing programs, used to evaluate and benchmark performance, accuracy, and test results, dealing with synthetic and designer drugs
• Interact with lawmakers and other organizations to convey the important contributions made by pathologists in addressing the opioid crisis
• Support the forensic pathology community in efforts to increase resources, the number of trained forensic pathologists, funding for forensic science, investigation, and certification
• Develop recommendations to ensure laboratories define testing methodologies, validate appropriately and provide interpretive results as dictated by clinical needs

At CAP18 in Chicago, on October 23, 2018, Barbarajean Magnani, PhD, MD, FCAP, CAP Toxicology Committee chair, will share her first-hand knowledge about the opioid epidemic. As a pathologist, Dr. Magnani works daily with physicians managing patients on chronic opioid therapy, as well as, those with acute unknown drug overdoses. By analyzing their toxicology results she provides the key that unlocks the lingering drug mystery. Dr. Magnani was also instrumental in drafting the CAP opioid position statement.

As the world's largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. For more information, read the 2017 CAP Annual Report at CAP.ORG.