To Automate or

Not to Automate
A Practitioner’s Review of Point of Care (POC) Drug Testing
and On-Site Automation.
Key factors and considerations to support decision making process to move to automation
To Automate or
Not to Automate
A Practitioner’s Review of Point of Care (POC)
Drug Testing and On-Site Automation.
Automation
supports
best
Automation

To Automate or Not to Automate

practice
The adult drug court model reduces criminal recidivism when it
adheres to evidence-based and best practices. Drug courts have the
potential to break the repeated cycle of incarceration, save lives, and
restore families at costs significantly less than traditional sentencing Certainty and
practices (National Drug Court Institute [NDCI], 2016; U.S. timing are
Government Accountability Office, 2011). As a result of drug courts’
success, multiple problem-solving courts have emerged that apply essential
similar operating components across a diverse set of priority areas, factors when
including child abuse and neglect, domestic violence, DUI’s, juvenile
administering
delinquency, mental illness, re-entering offenders, and veterans’
issues. Effective drug testing and monitoring is among those key incentives and
program components for every problem-solving court (NDCI, 2016). sanctions.
Drug courts are among the most studied criminal justice programs
and the results are clear. The model can reduce recidivism (rearrests) (Harrell &Roman, 2001;
Marlow& Kirby, 1999)
by 30 to 50% (Carey et al., 2012; Lowenkamp et al., 2005) with the
best outcomes achieved when high quality program services match
the needs of the target population (Marlowe et al., 2012; National
Association of Drug Court Professionals [NADCP], 2013 & 2015). To
quote NADCP, “Drug Courts Work,” but the best results come from
sound evidence-based and best practices (Marlowe et al., 2012;
Zweig et al., 2012). Drug testing is among the most vital practices
and the way in which services are operated matters. Candidly, not all
approaches are equal.
1
Currently, there are a few different options for how problem-solving
court professionals can operate their drug testing services. The most
common are Point-of-Care (POC) testing, such as instant cups and
 dipstick testing, or an in-house automated laboratory, which includes equipment such as an
analyzer. While there are pros and cons to each approach, automation is the clear winner
regarding accuracy, ease of use, and in many cases, cost.

Results Matter
Accurate drug tests drive better program outcomes. Automation adds significant improvements
to most of the limitations inherent with POC testing. POC does not offer quantitative data to
drive decision-making and often has cutoff levels that are too high for accurate drug use
interpretation. The practitioner also loses the ability to adjust drug panels to the changing
demands of your target population and accommodate new drugs of abuse. Automation
delivers on all these factors: semi-quantitative results, lower-level cutoffs, tailored drug panels
To Automate or Not to Automate

and error free reporting.

Automation allows for adjustable cutoff levels and semi-quantitative results that ensure the
most accurate picture of drug use history. Problem-solving court programs that rely solely on
POC testing for their drug tests are missing important information as many drugs are
metabolized at a high rate and concentrations may fall below POC levels of detection. Alcohol,
cocaine, methamphetamine and opioids all fall into this category. Lower cutoff levels and semi-
quantitative results make all the difference as to what you can uncover from a very narrow
detection window for most abused substances. While indication of sub-cutoff concentrations
should not necessarily result in sanctions, they are certainly a basis for further investigation and
increased monitoring. Your participants’ success and program integrity are dependent, in part,
on this information.

Problem-solving court programs can develop superior monitoring and compliance protocols
with the ability to monitor semi-qualitative results, even those below the standard cutoff levels.
A drug court coordinator who now uses a Thermo Fisher Scientific automated analyzer stated
that before moving to automation: “Without the ability to monitor flags and analyze levels [with
the semi-quantitative detection], participants would be graduating while using drugs the entire
time. Programs that do not look at levels are missing the point of what our clients do. They
manipulate.” Another drug court coordinator from Georgia shared: “Without the automated lab,
we would not be able to serve participants efficiently who abused alcohol. We would miss too
much.” Semi-quantitative results may further help programs with participants approved for
Medication-Assisted Treatment (MAT), as drug levels can be tracked overtime to monitor
compliance with prescription dosage. This is particularly important as MAT prescriptions such
as Buprenorphine and Methadone are subject to abuse. In addition, automation enables
2 practitioners to monitor THC/Creatinine ratios over time to help determine if a marijuana positive
is the result of new use or because of residual drugs in the system. This is specifically relevant
for new participants who have a history of chronic marijuana use.
THC can remain in their systems long after they have abstained, making abstinence monitoring
difficult in these cases; the THC/creatinine ratio enables you to easily determine if use is recent
or from prior use.

Automation indirectly supports effective behavior modification as certainty and timing are
essential factors when administering incentives and sanctions (Harrell & Roman, 2001; Marlow
& Kirby, 1999). Behavior modification, done well, is one of the accountability court practices
that sets the model apart from conventional programming and helps deliver the 30 to 50%
reduction in re-arrest rates. Automation delivers a superior level of detection for many drugs of
abuse, which means missing fewer incidents of use. That promotes improved program
responsiveness to participant behavior. Program administrators and judges can have
confidence that those responses are grounded in reliable data which minimizes human error
due to manual reporting and subjective interpretation of results. The same can’t be achieved
with POC.

To Automate or Not to Automate

Also, automation utilizes cutoffs that provide both information and insight, and allows for
tailored drug panels that make the most sense given participant drug use histories; this gives
practitioners high-confidence in the results, especially with the additional insights provided by
semi-quantitative data. The presence of an on-site analyzer gives the interdisciplinary team the
most accurate and timely information to make informed decisions in every participant’s case.

Perceived vs. Real Ease of Use

Many problem-solving court professionals believe that POC tests offer the simplest and
cheapest solution for their drug testing needs. In reality, these tests often coincide with a
greater reliance on confirmation labs that are costly and time-consuming. In addition,
subjectivity plays an uncomfortably large role in the interpretation of POC results. It was only a
faint line, so it must be negative, right? Given that these results can have real impacts on
participant liberties, this is a big concern.

Automation provides real ease of use and ease of mind. Greater confidence in the results
means less reliance on confirmation testing. Many of those time-consuming drug testing steps
are consolidated into the automated system’s functionality. Chain-of-Custody (COC) forms,
random screen assignment, flexible drug panels and other functions are all built into the
analyzer’s software capabilities. Thermo Fisher Scientific partners with ACT Innovations to
provide a software package called Paracelsus, which is a cloud-based data management
system. No need to worry about the test results being misinterpreted visually, as the analyzer
very accurately interprets the results for you. The results are sent via automatic emails to
designated team members who can view results in real time or simply log into the web portal.
3
 Paracelsus is one of the most user-friendly and intuitive systems available; it offers significant
utility including the ability to produce reports as well as invoices for those programs that decide
to generate revenue by providing outside screening services.

No highly trained medical professionals or toxicologists are needed to operate an automated

system. Most programs designate one or two members of their core interdisciplinary team to
run the analyzer. A few days of training is all you need for better results in perpetuity. Shortly
after your analyzer arrives, a Thermo Fisher Scientific representative will join you on-site to
install the equipment and provide training on-site to those who will be responsible for daily
operations. The training is provided at no cost to the consumer. Automation can be
established within modest space requirements as the analyzers take up no more bench space
than a couple of computers. When it comes to keeping it simple, Thermo Fisher Scientific has
real solutions.
To Automate or Not to Automate

Cost Effective
Two words: revenue generator. For many programs, it pays to automate because they offer
drug testing services to other programs or outside agencies. That revenue may fund or defray
screening costs and support other evidence-based services. Regardless of whether you
generate revenue from the lab or not, the cost per test is often at a lower cost-point than many
POC tests, depending on program census and frequency of testing. For medium to large
programs, it's often a no-brainer. While no problem-solving court has an unlimited budget,
automated solutions can provide better testing and more flexibility within your current program
budget.

The savings of moving to an automated lab may enable your program to do more within your
existing budget and reinvest savings into evidence-based treatment and supervision practices.
For example, an Ohio court that screens for multiple criminal justice programs yielded
substantial savings per month by moving to an automated solution provided by Thermo Fisher
Scientific. With the savings created they were able to reinvest into expanding the program to
support the community.
Two additional full-time screeners were hired which allowed probation staff to do less
specimen collection and more supervising of offenders toward better outcomes. It also allowed
the court to enroll more offenders into diversion programs and saved additional money by
cutting jail costs. In the words of the coordinator, “The previous approach cost more, was less
effective, and cut face-to-face time with offenders.”

4 Typically, there are no upfront costs to get started as there are multiple options for purchase
and billing, such as leasing or reagent rental based on the number of tests processed per
month.
You can work with a Thermo Fisher Scientific representative about your automation options,
compare costs with your current method and assess the value you receive with each option.

Drug testing is a critical program component for problem-solving courts. In fact, it is the very
foundation of a successful program. If drug testing is not performed accurately, it weakens the
effectiveness of every other evidence-based and best practice that your program provides,
from the courtroom to your curricula. While POC may appear to be the cheaper option on the
front end, there are hidden costs in lost information and flexibility that can affect outcomes. An
automated lab can help safeguard your program, provide better results, save money and
generate revenue in the process.

To Automate or Not to Automate

Advanced Outcomes Consulting Group, 2017
Authors: Andrew Cummings and Liam Harbry
[email protected]
[email protected]

References
 Carey, S.M., Mackin, J.R., & Finigan, M.W. (2012b). What works? The ten key components of drug court: Research-
based best practices. Drug Court Review, 8(1), 6–42.
 Harrell, A. & Roman, J. (2001). Reducing drug use and crime among offenders: The impact of Graduated Sanctions.
Journal of Drug Issues, 31(1), 207-232.
 Lowenkamp, C.T., Holsinger, A.M., & Latessa, E.J. (2005). Are drug courts effective? A meta-analytic review. Journal
of Community Corrections, 15(1), 5–11.
 Marlowe, D.B. (Ed.) (2012). Best practices in drug courts (special issue). Drug Court Review, 8(1).
 Marlowe, D. B. & Kirby, K. C. (1999). Effective use of sanctions in drug courts: Lessons from behavioral research.
National Drug Court Institute Review, 2, 1-32.
 National Association of Drug Court Professionals. (2013). Adult drug court best practice standards (Vol. I). Alexandria,
VA: Author. Retrieved from http://www.nadcp.org/sites/default/files/nadcp/AdultDrugCourtBestPracticeStandards.pdf
 National Association of Drug Court Professionals. (2015). Adult drug court best practice standards (Vol. II). Alexandria,
VA: Author. Retrieved from
http://www.ndcrc.org/sites/default/files/adult_drug_court_best_practice_standards_volume_ii.pdf
 National Drug Court Institute. (2016). Painting the current picture. A national report on drug courts and other problem
solving courts in the United States. Alexandria, VA, Retrieved from
http://www.ndcrc.org/sites/default/files/pcp_final_version.pdf
 U.S. Government Accountability Office. (2011). Adult drug courts: Studies show courts reduce recidivism, but DOJ
could enhance future performance measure revision efforts (GAO-12-53). Washington, DC: Author. Retrieved from
http://www.gao.gov/ assets/590/586793.pdf 5
 Zweig, J.M., Lindquist, C., Downey, P.M., Roman, J.K., & Rossman, S.B. (2012). Drug court policies and practices:
How program implementation affects offender substance use and criminal behavior outcomes. Drug Court Review,
8(1), 43–79.