At the 2023 Ontario Society for Clinical Chemists (OSCC) Annual Scientific Meeting, IQMH's Scientific Committee members, Danijela Konforte and Lei Fu, shared insights from the 2022 Chemistry patterns-of-practice survey, exploring current trends in pre-analytical and analytical practices related to alcohol, volatiles, and urine drug testing gathered from 197 licensed clinical laboratories across Ontario. The presentation delved into the changes and trends observed since IQMH’s 2011 Toxicology Guidelines prompting a meaningful roundtable discussion led by Consultant Technologist, Alex Kumaritakis.

Danijela Konforte discussed the role of language in addressing stigma, highlighting the direct and deep impact language can have on people. Guidance provided from documents by NIDA, PHAC, and HSO on communicating about substance use in non-stigmatizing, non-punitive, and non-judgmental ways was shared with attendees. Emphasis was placed on adopting person-first language to shift the narrative towards individuals rather than their illnesses, and choosing language that acknowledges and promotes that recovery from substance use disorder is possible.

Clinical research shows that certain words like ‘drug abuse(r)’, ‘drugs of abuse’, and ‘dirty samples’, engrained in the drug testing terminology, carry implicit bias which can contribute to stigmatization of people who use drugs and can present a barrier to seeking therapy and care. Clinical laboratories are in a unique position to advocate for use of non-stigmatizing, person-first language that is free of negative associations, individual blame, or punitive attitudes to promote safer care for all.

IQMH's intentional move to rename the "Drugs of Abuse" survey to "DRUG Urine (DRUG-UR)" in 2020 is a signal that we, too, are on a learning journey. We encourage clinical laboratories to adopt terminology that promotes a compassionate view of substance use as a public health concern when engaging with patients, colleagues, vendors, and policymakers.

Why is this important for patient safety?

Urine drug testing is a widespread tool in the management and treatment of both regulated and unregulated drug use. Drug testing should be used as a tool for supporting recovery rather than exacting punishment. It is a therapeutic, rather than punitive, component of treatment. Barriers to seeking treatment include stigma surrounding people who use drugs. The shift towards person-first language and communicating in a compassionate, safe, and non-stigmatizing way reduces health care avoidance in people who use drugs. These changes can be enacted by laboratories, providers, and institutes offering treatment and will promote non-stigmatization of the disease of addiction.

The 2022 Chemistry patterns-of-practice survey revealed that out of 188 responding laboratories in Ontario, 66% of them still use the term ‘drugs of abuse’, and 34% said they no longer use the term, and 16% (of the 34%) noted they replaced the term with ‘urine drug testing’. (Figure 1)

Figure 1. For urine drug testing, does your laboratory still routinely use the term ‘Drugs of Abuse (DOA)’? (n=188)

Read more about the impact language can have on people below, and how your laboratory can make impactful changes to promote safer care.

National Institute on Drug Abuse. Words Matter – Terms to Use and Avoid When Talking About Addiction. Published November 29, 2021. Available from: https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction

Government of Canada: Communicating about Substance Use in Compassionate, Safe and Non-Stigmatizing Ways. Published January 2020. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/communicating-about-substance-use-compassionate-safe-non-stigmatizing-ways-2019.html

Health Standards Organization. (2023). Mental Health and Addictions Services (CAN/HSO 22004:2023 (E)). https://store.healthstandards.org/products/mental-health-and-addictions-services-can-hso-22004-2023-e