Drug Overdoses are Surging with COVID

Shadowbox Tech Offers Help to Struggling Addiction and Treatment Providers

February 17, 2021

By Gregory A. Stein and Andrea G. Barthwell, MD, DFASAM

The number of drug overdose deaths in the US reached a record high last spring, rising in tandem with the first wave of Coronavirus cases.  According to the U.S. Centers for Disease Control (CDC), more than 81,000 people died from an overdose in the 12 months ended May 2020 – the largest number ever recorded.

The US Department of Health and Human Services, the National Institutes of Health, the Centers for Disease Control, and the American Medical Association have each published reports on the significant impact the Coronavirus pandemic is having on mental health.  Interventions meant to flatten the coronavirus curve, such as travel restrictions, business constraints, and limitations on social gatherings (combined with personal prevention efforts such as mask wearing, social distancing, and frequent hand washing) have proven effective in reducing the transmission of the disease. That said, there are unintended mental health consequences caused by social isolation and a lack of group activities; these losses can be devastating to the nearly 18 million Americans battling substance use disorder.

In addition to the deaths caused by the virus itself, the pandemic is also linked to a surge in overdose deaths.  Whereas drug overdose deaths had been trending flat to declining since 2017, the onset of COVID triggered a resurgence of overdoses, reversed the trend, with recorded deaths increasing by  nearly 20% versus prior year.  This is occurring despite  a 37% decrease in opiate prescriptions since 2014.  In fact, more than 19,000 people died of an overdose in just the first three months of 2020.

This trend is likely to have accelerated, with a significant increase in total overdose deaths expected once full statistics are in for 2020.  One leading indicator was the release of a US DHH study revealing that a sample of a half million urine drug tests processed in the four months prior to March 2020 vs. tests processed in the four following months showed that patients were:

    • 67% more likely to test positive for fentanyl;
    • 33% more likely to test positive for heroin;
    • 23% more likely to test positive for methamphetamine;
    • 19% more likely to test positive for cocaine.

The numbers regarding fentanyl are particularly disturbing as they represent an ever-increasing proportion of drug related deaths due to its extremely powerful chemistry and inexpensive production costs.

As a result, it is more important than ever to enable access to treatment, and provide the support and resources to the nation’s more than 14,500 specialized drug treatment facilities and their clinical and front-line staff.  These facilities rely on three key resources to support their treatment plans:

    1. Definitive urine drug testing (UDT) identifies the substances that are present in a patient’s body to ensure safety and safeguard the welfare of patients and confirm they are responding to the current treatment plan and level of care.
    2. Prescription drug management databases (PDM) to protect patients from being prescribed drugs that cause unsafe drug-drug interactions and to account for how much is being taken by the patient during an interval of care.
    3. Predictive analytics regarding a patient’s potential for use of unprescribed medications or medications being used in ways other than intended that can proactively trigger a clinician intervention.

While each of these resources are independently valuable to treatment centers, they work best in concert.   At Shadowbox, we are introducing new technology, working in partnership with addiction and treatment providers, to simply and rapidly bring these resources together to enhance treatment, improve patient outcomes, and ultimately save lives.

Today, clinicians use Shadowbox to order thousands of urine drug tests and prescription drug management database reports every month.  These orders are automated and simplified by our patented low code interface technology. Shadowbox is poised to launch the third component –the collaboration of information across systems (patient information in the clinic’s electronic health record [EHR] system, UDT results data, and PDM reports) that will ultimately feed an Artificial Intelligence (AI) engine and respond with evidence based predictive analytics that can be used by the provider to check in with the patient to assess if more support is needed.  The beauty of the Shadowbox architecture is that as new data sources come online, they can be quickly added to the Shadowbox application and used to improve the predictive value of the AI.

With many of the nation’s UDT providers rapidly pivoting last year to also provide high quality molecular diagnostic tests to diagnose COVID-19, it is now possible to include positive test results in the analytics and measure the significance of contracting the disease has on patient outcomes.

We are just getting started with the interoperability potential enabled by Shadowbox technology and are excited to apply our innovation to help save and improve lives.

For more information about Shadowbox, please schedule a demo.

Gregory A. Stein is CEO of Shadowbox

Andrea G. Barthwell, MD, DFASAM, is a former Deputy Director of the US Office of National Drug Control Policy and serves on the Shadowbox Board of Advisors

Why Crowdsourcing Can Unlock the COVID-19 Test Bottleneck


October 5th, 2020

By Greg Stein


You are running a 103 temperature and struggling to breathe.  Despite your delirium, you drive to a COVID testing site where the line is so long that it stretches several city blocks.

And then you wait.

And wait.

And wait.

But the wait for the test is nothing compared to the lag to get test results. According to the San Francisco Chronicle, delays in test results were as bad as 19 days. By then, you have either checked into a hospital, recovered, or quarantined for absolutely no reason. Or worse, you gave up mid-quarantine, and infected your elderly neighbor.

There is a better way.

The solution is to distribute testing through the existing healthcare infrastructure – the primary care clinician.  Back in early 2020, when we knew far less about COVID-19, it was not appropriate for everyday clinics to handle a potentially deadly and extremely contagious disease.  But now it is time to shift the paradigm back to the way healthcare operates most efficiently – away from the emergency room and into the primary care setting.

How will the individual primary care Doc get test kits and receive test results when giant institutions such as hospital labs, public agencies, and major labs are doing everything they can just to keep up with demand?

The answer is crowdsourcing.

(Photo by Kevin Winter/Getty Images)


There are more than a thousand labs around the country – many of whom have already stood up COVID-19 test capability.  From a couple hundred to a couple thousand daily test capacity, these labs collectively represent hundreds of thousands of daily test capacity able to be rapidly shifted to hot spots around the country. Labs can accelerate and automate the results process using innovative technologies such as the Shadowbox created “COVID-19 DX HUB”.

Now imagine you have that fever, but in a crowdsourced distributed site world.  You visit your doctor and she assesses your symptoms.  If a test appears appropriate, the sample is professionally collected in a controlled environment to reduce spoilage, and the order is made electronically while collecting all the federally mandated patient information.  The sample is then shipped overnight to one of the crowdsourced labs with results provided electronically within 48 hours – enough time to provide clear clinical direction relative to the outcome of the test. Simple, safe, and accurate with no more crowds, long lines, or false results.

Much better.



In the Fight Against Coronavirus, the Feds May Have Done Something Right


August 29th, 2020

By Gregory A. Stein and James Dieter


Everything from op-eds to angry tweets are being written about the US Government’s apparent missteps in addressing the Coronavirus (COVID-19) pandemic.  Buried in the back pages, however, are new regulations implementing the 21st Century CURES Act (Cures Act) that may have a powerful impact on combating the disease).

The Cures Act was enacted to accelerate medical product development and deliver innovative healthcare advances to patients who need them faster and more efficiently. Signed into law in December 2016, these regulations provide protections for technology companies enabling them to improve patient care through innovation, integration, and information transparency.

The new regulations encourage technologies designed to help patient data flow more efficiently across the healthcare ecosystem, while still maintaining patient privacy and security. It also prevents technology incumbents from blocking a clinician or patient’s access to the electronic health information stored on their systems.

So how does this enhance the fight against Coronavirus? Part and parcel to ubiquitous access to Coronavirus testing, is ensuring that information flows quickly and efficiently to the right place. To stem the tide of the virus, we need to know who has been exposed, how they are reacting, and whether to quarantine in place or hospitalize.  All these data points can be answered by diagnostic laboratory testing – and laboratories are responding.

Diagnostic laboratory companies like Principal Health Systems (PHS) have developed tests to address these concerns. PHS is specifically focused on nursing home care, where the risk of dying from COVID-19 can be as high as 15%. Early testing can clearly save lives, especially for those who are at high risk.  However, the availability of testing is merely half the battle, the other half is getting those tests into the hands of doctors as quickly as possible.

Today, if a clinician wants to order one of these lab tests, that lab must be “integrated” into that clinician’s electronic health record (EHR) software.  But what if they aren’t?  In that case, the clinician must write an order on a piece of paper and – we aren’t kidding here – FAX it to the lab.  In some cases, the lab may have an online ordering portal, but even then, the clinician must now perform data entry which is both time consuming and a high potential for error.

If the lab wants to integrate with that clinician’s EHR, they must be willing to invest thousands of dollars per location, commit internal IT staff, and if everything goes smoothly, get the integration up and running in a few months.  In the crisis environment in which we are operating today, this is simply unacceptable.  We don’t have a few months to make tests available everywhere.  Even a single days’ delay can result in exponential expansion of infections.

The CURES Act now allows labs and doctors toinstantly integrate.” This means the innovative lab paired with the innovative software technology can offer tests to clinicians within minutes of a request.  Technology companies such as Shadowbox are specialized in the lab and healthcare integration space to accelerate the integration of systems to allow doctors to electronically order a test from an otherwise non-integrated lab that day.  These orders and their results are securely, compliantly, and securely exchanged between systems in seconds.

We believe that every person desiring to be tested for COVID-19 should have access to, and payer support for, immediate and periodic testing; for peace of mind, for informed behavior changes, and for the sake of protecting our loved ones and community. While there is still much to do to ensure the widespread availability of diagnostic tests, The CURES Act rules now make it easier and far faster to access those tests and receive results.


Gregory A. Stein is the Co-Founder and CEO of Shadowbox, Inc. – a technology start-up bringing disruptive innovation to healthcare.

James Dieter is the Founder and CEO of Principle Health Systems – a multi-faceted healthcare ancillary services provider focused on services and support for skilled nursing facilities, hospice, and at-home healthcare organizations.