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Urine drug testing (UDT) is an important part of providing care to individuals with substance use disorders, from confirming baseline substance use to evaluating treatment outcomes. However, many individuals have had negative experiences with UDT. When UDT procedures feel punitive, it can impact whether an individual will continue to access care.
In this episode of the Addiction Practice Pod, Dr. Marcus Greatheart and David Ball talk with family nurse practitioner Tracey Day about how to effectively communicate with a patient about UDT and build a care plan collaboratively. We also hear from peer navigator and clinical care advocate Reija Jean, on the impact of negative UDT experiences, and how care providers can build respectful and safe therapeutic relationships.
- Identify when it is appropriate to utilize urine drug testing (UDT) in patient care.
- Effectively communicate with a patient about the purpose of UDT and how it will be used to inform decisions about treatment.
- Describe how care plans may be adjusted based on unexpected UDT results.
- Identify strategies to incorporate patient-centered care in UDT.
In this episode, you’ll hear:
- 2:50 – Tracey Day – Clinical Director, Substance Use and Addictions at Carrier Sekani Family Services; Clinical Advisor, Ministry of Mental Health and Addictions and Overdose Emergency Response Centre
- 13:49 – Reija Jean – Vice President, BC Association of People on Opiate Maintenance; Peer Navigator, BC Centre on Substance Use
Here’s what listeners can take away from this episode:
- A urine drug test should only be used when the result would change clinical management; however, it should not be the only factor considered when making treatment decisions. In the case of managing opioid agonist treatment (OAT), examples include confirming baseline opioid use, informing changes to treatment, or identifying substances a patient may not be aware they were exposed to.
- Clinicians should provide patient-centered care by being transparent with patients about the purposes of urine drug testing and discussing how results may impact care. Clear expectations should be set and treatment plans and any adjustments should be developed collaboratively with the patient.
- When unexpected urine drug test results occur, clinicians should discuss the results with their patient and determine how to adjust the treatment plan, prioritizing patient goals and safety. Punitive measures, such as discontinuing OAT due to a positive urine drug test for opioids or other substances, should not be taken.
- As a health care provider, it is important to recognize and acknowledge the power imbalances between a patient and provider, especially in the context of substance use care and urine drug testing. Care providers should actively work to create safer spaces for patients to receive care without judgement and stigma. This involves building trust over time through compassionate care and open communication.
- British Columbia Centre on Substance Use. Urine Drug Testing in Patients Prescribed Opioid Agonist Treatment: Breakout Resource. 2021.
- Barthwell AG, Allgaier J, Egli K. Definitive urine drug testing in office-based opioid treatment: a Literature review. Crit Rev Toxicol. 2018;48(10):829-852.
- Dupouy J, Mémier V, Catala H, Lavit M, Oustric S, Lapeyre-Mestre M. Does urine drug abuse screening help for managing patients? A systematic review. Drug Alcohol Depend. 2014;136:11-20.
- Incze MA. Reassessing the Role of Routine Urine Drug Screening in Opioid Use Disorder Treatment. JAMA Intern Med. 2021;181(10):1282-1283.
- Marchand K, Beaumont S, Westfall J, MacDonald S, Harrison S, Marsh DC, Schechter MT, Oviedo-Joekes E. Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Subst Abuse Treat Prev Policy. 2019;14(1):1-5.
- McEachern J, Adye-White L, Priest KC, et al. Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy. Int J Drug Policy. 2019;64:30-33.
- NEJM Catalyst. What is patient-centered care? NEJM Group. 2017.
- Reisfield GM, Maschke KJ. Urine Drug Testing in Long-term Opioid Therapy: Ethical Considerations. Clin J Pain. 2014;30:679-684.
- Taha SA, Westra JR, Raji MA, Kuo YF. Trends in Urine Drug Testing Among Long-term Opioid Users, 2012–2018. Am J Prev Med. 2021;2020;60:546-551.
- British Columbia Centre on Substance Use (BCCSU). Ordering and Interpreting Urine Drug Tests for Opioid Agonist Treatment (OUD ECHO) [Video]. YouTube. Published June 23, 2022.
- BCCSU. Decoding Urine Drug Tests (OUD ECHO) [Video]. YouTube. Published February 11, 2021.
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