Testimonies from the Trenches Series - Reconsidering the Role of Urine Drug Testing in OUD Treatment (On-Demand)-Event Handout

Event Handout

Pdf Summary

This document is a presentation or discussion on the role of routine urine drug testing (UDT) in the treatment of opioid use disorder (OUD). The author, Dr. Utsha Khatri, explores the potential harms and benefits of UDT and reviews the existing literature on the practice. <br /><br />The origins of UDT are traced back to the 1960s and have been implemented in various settings, such as methadone treatment and workplace testing. Potential harms of UDT include damage to the clinician-patient relationship, traumatic experiences for patients with histories of violence or criminal justice involvement, and unintentional incentivization to falsify results. On the other hand, potential benefits of UDT include motivation for some patients, documentation required by nonmedical agencies, assistance in addressing diversion concerns, and identification of patients in need of additional support or changes to their treatment plan. <br /><br />The review of literature cited in the document suggests that there is currently insufficient evidence on the effectiveness and impact of UDT testing frequency for individuals on opioid agonist therapy (OAT). The document emphasizes the importance of using UDT as one of several methods to monitor substance use and treatment, and interpreting test results in conjunction with collateral and self-report information. The American Society of Addiction Medicine (ASAM) provides guidelines for the appropriate use of drug testing in clinical addiction medicine, which highlight the use of random testing for stable patients and the assessment of patient goals and experiences. <br /><br />The document ends with a set of discussion questions, including inquiries into clinicians' attitudes towards UDT, experiences during the COVID-19 pandemic, institutional barriers to implementing changes in UDT practices, and patient-centered considerations. <br /><br />Several resources are provided for further reading, including articles on the harms and benefits of UDT, the history of UDT, and the association between frequent UDT and health outcomes for individuals on OAT.

Keywords

routine urine drug testing

opioid use disorder

UDT

harm reduction

benefits of UDT

literature review

methadone treatment

workplace testing

clinician-patient relationship

diversion concerns