Essentials: General Principles of Drug Testing-Event Handout

Event Handout

Pdf Summary

Drug testing is an important component of office-based treatment (OBOT), as it can help patients follow treatment recommendations and assist providers in treatment planning. It is not meant to catch patients, but rather to provide opportunities for reviewing the patient's recovery management. Laboratory testing plays several roles in OBOT, including initial assessment, treatment planning, screening for non-prescribed substances, monitoring adherence to medication-assisted treatment (MAT), and evaluating treatment efficacy. Urine is the most common matrix for drug testing due to its availability, sensitivity, specificity, and ability to detect substance use over a useful period of time. Screening tests are commonly used to test for substances, and confirmatory tests are performed only for positive results that require accuracy for treatment planning. Some common substances tested include opioids, buprenorphine, fentanyl, oxycodone, benzodiazepines, cannabinoids, amphetamines, cocaine metabolite, and alcohol metabolite. Testing for buprenorphine during MAT can be helpful to monitor adherence and detect possible diversion. It requires its own specific screening and confirmatory tests. Urine samples can be altered in various ways, such as adding substances, diluting with water, or providing a sample produced by another person. It is important to develop a clinic policy that outlines the consequences of positive tests and to review medication dose, treatment intensity, and frequency of testing based on test results. The frequency of urine drug testing (UDT) depends on factors such as the stage of treatment, stability of the patient, half-life of the drugs being tested, and treatment setting. Familiarity with the local laboratory and the costs of testing is also advisable. A medical review officer (MRO) is responsible for verifying test results and ensuring the accuracy and integrity of the drug testing process. The MRO must have specific qualifications and perform various duties, including verifying test results involving specific drug classes. Validity testing is conducted to determine if a specimen is consistent with normal human urine, and dilution and substitution are factors considered in validity testing.

Keywords

drug testing

office-based treatment

treatment planning

urine testing

medication-assisted treatment

substance testing

buprenorphine

diversion monitoring

clinic policy

validity testing