The Importance Of Drug Monitoring In Treatment

Drug testing in treatment is more appropriately described as monitoring of the patient’s success in abstaining from the substance(s) that put him or her into treatment in the first place. There are several elements to an effective monitoring program, including:

  • Drugs tested for,
  • Type of test,
  • Selection of individuals for testing, and
  • Ancillary counseling sessions.

The most basic program tests for the “NIDA-5”: opioids, cocaine, marijuana, PCP, and methamphetamines. However, more specific assays are now available for synthetic marijuana (“spice”, “K-9”, etc.), bath salts (synthetic cathinones), and the so-called “club drugs” that are frequently used and abused by adolescents. Tests are also available for methadone.

Urine testing is probably the most common form of drug testing, due to its low cost, efficiency, and low level of invasiveness. Technology now allows negative results to be identified and verified quickly at the point of specimen collection. Home testing kits, easily found in pharmacies and online, can be convenient for parents; however, the substances for which they test are limited. Drug testing using blood samples is considered invasive and requires a level of training on the part of the tester, although more accurate results and a wider range of drugs can be assayed than with other methods. Hair samples and oral swabs can also be assayed for drug use.

Drug testing can produce false positive results, for example, if the individual has taken a prescribed medication or even eaten a large quantity of something as innocuous as poppy seeds. A qualified Medical Review Officer is trained to certify the validity of questionable results and to determine if the donor has a legal prescription for a positive drug test. If so, it is ruled negative.

A third component of a monitoring program is how individuals are selected for testing. Random, unpatterned selection means that the individual cannot anticipate testing and must be drug-free at all times. The individual is usually told to report for a test within a certain limited time frame. If individuals are told they’ll be tested at regular intervals, they can adjust their substance use accordingly (with the likely exception of marijuana which can be retained by the body for about a month). Testing due to behavioral issues is conducted for cause.

Monitoring for substance misuse and abuse works best when it is coupled with psychosocial counseling sessions to support the patient’s sobriety and address issues that might lead the patient to revert to his or her drug use. The frequency of the sessions can vary, commensurate with the individual’s level of recovery. Monitoring has been shown to improve treatment compliance and enhance positive outcomes.

Substance use disorder—addiction—does not go away, it can only be held at bay, as with other chronic, relapsing diseases.

Resources

American Society of Addiction Medicine (ASAM). (2002, 2010). Public policy statement: Drug testing as a component of addiction treatment and monitoring programs and in other clinical settings. Retrieved from https://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/drug-testing-as-a-component-of-addiction-treatment-and-monitoring-programs-and-in-other-clinical-settings.

Blum, K., Han, D., Femino, J., Smith, D. E., Saunders, S., simpatico, T.,  … Gold, M. S. (2014) Systematic evaluation of “compliance” to prescribed treatment medications and “abstinence” from psychoactive drug abuse in chemical dependence programs: Data from the comprehensive analysis of reported drugs. PLoS ONE, 9(9), e104275. doi:10.1371/journal.pone.0104275

Skipper, G. E., & DuPont, R. L. (2011) The physician health program: A replicable model of sustained recovery management. In J. F. Kelley and W. L. White (Eds.), Addiction recovery management: Theory, research and practice, current clinical psychiatry (pp. 281-302). Springer Science+Business Media.