Consensus Document Provides Practical Guidance on Drug Testing in Addiction Medicine

The American Society of Addiction Medicine has issued a consensus document to guide the appropriate use of drug testing in patients with or at risk for addiction.

The recommendations in the consensus document were drawn from evidence from more than 100 studies and were developed using an “Appropriateness Method” process that integrates the collective views of multidisciplinary experts with scientific evidence.
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The document offers an array of practical recommendations across clinical settings and emphasizes that drug testing should be combined with a patient’s self-reported information on substance use.

According to the document, drug testing should be presented to patients as therapeutic rather than punitive. If there are discrepancies between what the patient reports and what the test indicates, clinicians should be encouraged to use the opportunity to therapeutically engage with the patient. Drug testing may also be a useful therapeutic tool to discuss denial, motivation, and substance use behaviors with patients.

The consensus document covers the use of drug testing in assessment, with recommendations that testing be conducted at intake as part of developing the patient’s treatment plan. Testing, though, should be used in conjunction with history, psychosocial assessment, and physical examination.

Frequency of testing is also addressed. The Expert Panel recommends testing at least once a week in early recovery. As recovery progresses and the patient stabilizes, frequency can be scaled back but should occur at least monthly. Regardless of the frequency, random testing is preferred over fixed testing schedules whenever possible.

Other areas discussed include documentation, patient confidentiality, practitioner education and expertise, appropriate terminology for patient communication, and test facilities and devices. Guidance is offered on choosing the type of test and on responding to unclear test results.

A section of the consensus document specifically focuses on opioid treatment services. Special considerations for adolescents and for pregnant women are also covered.

—Lauren LeBano

Reference

Jarvis M, Williams J, Hurford M, et al. Appropriate use of drug testing in clinical addiction medicine. J Addict Med. 2017;11(3):163-173.