Drug Testing Early in Treatment Can Enhance Care

Results of a study performed by Boston Medical Center point out why it can be critically important to conduct drug testing early in treatment for patients with opioid use disorders.

Published in the journal Drug and Alcohol Dependence, the study found that 57% of opioid-positive urine drug tests occurred in cases when outpatients had not disclosed recent substance use during their treatment visit to a buprenorphine clinic. The percentage of these instances was even higher for cocaine-positive tests, at 76%.

The odds of positive tests without self-reported use were higher earlier on in treatment (in the first 180 days for opioids and in the first 90 days for cocaine), the researchers reported.

The study encompassed a retrospective review of more than 1,700 drug tests from 130 patients treated in an office-based buprenorphine program between January 2011 and April 2013.

“Patients may not be self-reporting substance use early on in their treatment due to concerns about being discharged from programs if they disclose use, or they may feel shame about relapse and do not want to disappoint the care team,” said study co-author and Boston Medical Center internist and pediatrician Sarah M. Bagley, MD.

The fact that the rates of positive tests without self-reported use decreased over time suggests that rapport builds between patients and clinicians over the course of treatment. This makes the case for why it can be important to use drug testing as a treatment tool but not an intervention that leads to strict sanctions such as removal from a treatment program.

Study authors stated that the results reinforce guidelines that call for urine drug testing as part of office-based addiction treatment services, but with a decreasing frequency of testing as patients begin to demonstrate greater stability in their recovery.