Drug testing is an important clinical tool. What do we know about doing it well?
A few years ago, IRETA hosted a webinar called You Can’t Fool the Bladder Police on the effective use of urine drug screening in addiction treatment settings. It was extremely well-attended. Since then, the recorded webinar has been viewed hundreds of times on YouTube (although we are left to wonder how many viewers were looking for ways to fool the bladder police).
For residential and outpatient addiction treatment providers–not to mention methadone clinics and primary care docs prescribing addiction medications–drug testing is an important clinical tool. Drug testing can also be expensive, inaccurate, and punitive. So what do we know about doing it well? How can drug testing improve the quality of patient care and help guide more folks toward recovery?
Working with the American Society for Addiction Medicine (ASAM), IRETA has begun a project to consolidate research literature and expert clinical opinion into an appropriate document on drug testing for patients with addiction. From the ASAM website:
The drug testing appropriateness document will focus primarily on the use of drug testing for purposes of identification, diagnosis, treatment, and promotion of recovery for patients with addiction. While urine drug tests (UDT) are the most commonly utilized test in clinical practice, including addiction treatment, many technological advances have been made in the field. The project will address the potential usefulness of other testing types, including, for example, blood, saliva, hair, and sweat. Similarly, while presumptive tests are most commonly utilized, definitive tests may be more appropriate in some situations, which will be addressed as well.
Because patients with addiction are seen and treated in a variety of settings and levels of care, all potential settings where drug testing might be useful will be covered. The appropriateness document will be organized by ASAM’s levels of care, including outpatient, intensive outpatient, residential inpatient, and opioid treatment services. Drug testing for opioid treatment services will also be covered, including their delivery across a variety of treatment settings (e.g., residential inpatient, daily methadone maintenance, and other medications in the context of office practice).
ASAM is working with the Institute for Research, Education and Training in Addictions (IRETA), which has begun a literature review that will expand upon currently available materials, including ASAM’s recently published white paper on the science and practice of drug testing. There will be a formal review of research literature focused on determining whom to test, which drugs to test for and which types of tests to use, and clinical interpretations of these tests.
Read more about the project methodology and the anticipated release date of the final document on ASAM’s website.
This will be the third appropriateness document that IRETA has produced using a research methodology called the RAND/UCLA Effectiveness Method. Other topics include the effective use of buprenorphine for opioid use disorders and the management of benzodiazepines in medication-assisted treatment. Each project aimed to provide clinical and administrative guidance to improve patient care.
We are delighted to partner with ASAM to examine the practice of drug testing as a clinical tool that can be optimized.
“IRETA helps people respond effectively to substance use and related problems,” said Peter Luongo, Ph.D, IRETA’s Executive Director. “We believe that creating a drug testing appropriateness document is a way to do just that: propagate effective practices and reduce ineffective practices so, at the end of the day, more people get better.”