Clinical and Public Health Considerations in Urine Drug Testing to Identify and Treat Substance Use

Abstract

The author makes recommendations for determining the methodology, scope, and frequency of testing in each stage of care based on clinical considerations and methodological factors. Conclusion/Importance: Integrating sensible substance use testing broadly into clinical health care to identify substance use, diagnose substance use disorders, and guide patients into treatment can improve health outcomes and reduce the costs of substance use and addiction. No single testing regimen is suitable for all clinical scenarios; rather, a multitude of options, as discussed herein, can be adapted to meet a patient's unique needs. Ultimately, the practitioner must combine patient-specific information with knowledge of test technologies, capabilities, limitations, and costs.

Demanding Better: A Case for Increased Funding and Involvement of State Medical Boards in Response to America’s Drug Abuse Crisis

“…86 Moreover, addiction treatment experts recommend that primary care, pain medicine, emergency medicine, psychiatry, obstetrics and surgery practitioners implement routine screening for problematic substance use. 87 Screenings for SUDs should also be a part of the law enforcement intake processes, ideally being conducted before an individual's arrest and booking. 88 Per the National Conference of State Legislatures, as of 2017, 23 states have statutorily authorized medical boards under any of their priorities, nor does any such funding appear in the FY 2021 proposal.…”

Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy

“…In the context of OUD care, Urine Drug Screening (UDS) is used as either i) a screening tool (i.e., presumptive), conducted in the point of care setting, or ii) a confirmatory test (i.e., definitive), generally conducted in the laboratory setting (ASAM, 2017). In primary care, UDS can be used to detect or validate self-reported drug use in OUD treatment (Barthwell, 2016; British Columbia Centre on Substance Use & CIHR Canadian Research Initiative on Substance Misuse, 2017), and monitor adherence to OAT. In this context, the frequency of UDS could have significant impacts on retention and adherence to treatment, with higher frequency schedules potentially resulting in greater benefits to OAT-treated patients.…”

Large Variation in Provincial Guidelines for Urine Drug Screening During Opioid Agonist Treatment in Canada

“…3 In the context of OUD treatment, UDS detects or validates the self-reported use of opioids, or other drugs, in order to monitor efficacy of treatment. 3,4 Furthermore, UDS is frequently used to monitor adherence to OAT and its potential diversion. 4…”

“…The risks of diversion and overdose associated with methadone and SROM are greater than those for buprenorphine. 4 Due to this variance in safety profiles, the published guidelines for UDS differ for the different forms of OAT. 4 The addition of new treatment options for OAT (including SROM and iOAT) presents specific challenges for interpretation of UDS results, as it is difficult to distinguish between non-prescribed and prescribed opioids.…”

“…4 Due to this variance in safety profiles, the published guidelines for UDS differ for the different forms of OAT. 4 The addition of new treatment options for OAT (including SROM and iOAT) presents specific challenges for interpretation of UDS results, as it is difficult to distinguish between non-prescribed and prescribed opioids. 4 This further warrants the development of UDS guidelines specific to treatment type.…”