Improving opioid agonist care continuation remains to be a challenge for many community based addiction treatment organizations. Research into effective strategies has used both randomized and non-randomized designs. Is there any difference in treatment dropout between these different study types? (more…)
Gaps in addiction medicine training are a reason for poor substance use care in North America. (more…)
Although opioid agonist treatment is effective in treating opioid use disorders, retention in such treatment is suboptimal in part due to quality of care issues. A new initiative sought to boost treatment of opioid use disorders so that people stay there longer. This article describes how teams did in a structured quality improvement initiative in Vancouver, Canada. (more…)
Canada and the United States (U.S.) face an opioid use disorder and opioid overdose epidemic.
The most effective OUD treatment is opioid agonist therapy (OAT). It means buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited treatment access. (more…)
Frequent drug tests in addiction treatment have become a common practice despite proven benefits of such testing. When do tests become the end instead of the means to health and wellness?
In a previous post, I have explained how there was no agreement on the frequency of drug testing in Canada. Not until March 2018, when the British Columbia Centre on Substance use released the National guidelines for opioid use disorder. This article looks at the scientific evidence (or the lack of it) for frequent drug testing in addiction treatment. Read more or watch podcast below:
What is the study about?
We wanted to find out whether frequent urine drug tests correspond with better outcomes of treatment with opioid agonists such as methadone or buprenorphine.
How we did the study ?
We looked at the scientific literature from 1995 up until the end of 2017.
Then, we wanted to see how often the screening should be done while in the opiod agonist treatment. In the study, we included people of any gender, age or ethnicity.
Frequent drug tests lack evidence
We found only one higher quality studies with patients from USA.
The study compared weekly and monthly urine drug testing with take-home doses of opioid agonists.
Our review identified an urgent gap in research evidence underpinning an area of clinical importance and that is routinely reported by patients as an area of concern
Why is the study important?
Opioid use disorder is a chronic condition impacting the reward, motivation and memory pathways of the brain (ASAM, 2017).
Opioid agonist therapy is a first-line treatment for opioid use disorder.
The frequency and role of urine drug screening in opioid agonist treatment has received little research attention.
Although prior evidence suggests that testing frequency reflects philosophy and practice context, rather than differences in patient characteristics or clinical need, frequent urine testing remains under-researched.
Finally, the editorial of the Canadian Journal of Addiction featured this study as important for bringing additional management aspects for consideration:
McEachern J, Adye-White L, Priest KC, Moss E, Gorfinkel L, Wood E, Cullen W, Klimas J: Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy. International Journal of Drug Policy 2019, 64:30-33.