Urine Drug Testing

Why we do it

When we do it

How we do it

What do we test for

Problems & Limitations

Why Test?

• Test to confirm the history of drug use given by the client

• Provides accountability for the client• Provides a way for us to document drug

use or abstinence • Confirms stability or identifies relapse

therefore enhances safety when giving carries

When do we test?

• At admission to the program to document the use of opiate

• Throughout stabilization to document progress

• In maintenance phase to document abstinence as part of monitoring stability to allow carries to be given

• Can identify if ongoing drug use is contributing to persistent difficulties

How Often?

• More frequent e.g.weekly testing while working towards carries

• Less frequent when stable

• Ideal would be random testing

• More practical is testing at apts.

How : Sample Collection

• Take measures to reduce chances of sample dilution, adulteration, or substitution

• Direct observation? - not at AFM• Leave bags, bulky outdoor clothing, empty

pockets• Designated urine sample collection area -

ideally with ‘blued toilet’ & no access to tap water until sample is handed over

• Temperature strip on bottle

Testing Methods

• Immunoassay - drug class specific– Does not identify individual drugs in each

class

GC/MS - gas chromatography/mass spectrometry - can identify a specific drug or metabolite

Point of care testing is easy & quick but costly

Point of care testing

What do we test for?

• Methadone to confirm it’s presence• Opiates including oxycontin• Cocaine• Benzodiazepines• Marijuana? • Alcohol use is important - but not part of urine

drug testing

Problems & Limitations

• “I can’t pee” or I just went• “I haven’t used since the last apt but I

took a Tylenol #1 for a headache yesterday”

• Urine is cold - did they bring it with them? Did they dilute it?

• Urine is negative for everything - including Methadone

Problems & Limitations

• Benzodiazepines & Marijuana persist for several weeks

• All other drugs only test positive for a few days

• Oxycontin does not test positive in most opiate immunoassay tests

• No test for Fentanyl• Clonazepam & Alprazolam test negative on

immunoassay for benzodiazepines