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Drug Testing and Medication-Assisted Treatment

Opioid use disorder (previously called opioid dependence) is defined by the American Society of Addiction Medicine (ASAM) as “a chronic, relapsing disease, which has significant economic, personal and public health consequences.”1 The treatment of opioid use disorder often requires a multimodal approach that may include psychosocial therapy together with medication-assisted treatment (MAT). MAT has been shown to improve treatment retention and substantially reduce morbidity and mortality.2 Buprenorphine and buprenorphine combination products, such as buprenorphine/naloxone (Suboxone®), reduce opioid cravings and withdrawal symptoms and are commonly used in MAT.2, 3

Generally, the purpose of drug testing during treatment of opioid use disorder is to monitor the effectiveness of a patient’s treatment plan. Published literature has shown that self-report of medication and/or substance use is not reliable in numerous healthcare populations, including patients with substance use disorder (SUD).4

References:

  1. Kampman et al. National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. American Society of Addiction Medicine. 2015. www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-nationalpractice-guideline-supplement.pdf?sfvrsn=24. Accessed November 2018.
  2. Substance Abuse and Mental Health Services Administration (SAMHSA) Advisory. Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update. 2016;15(1). HHS Publication No. (SMA) 16-4938.
  3. Hurford et al. Consensus Statement: Appropriate Use of Drug Testing in Clinical Addiction Medicine. American Society of Addiction Medicine. 2017. www.asam.org/resources/guidelines-and-consensus-documents/drug-testing. Accessed November 2018.
  4. Chermack ST1, Roll J, Reilly M, Davis L, Kilaru U, Grabowski J. Comparison of patient self-reports and urinalysis results obtained under naturalistic methadone treatment conditions. Drug Alcohol Depend. 2000 Apr 1;59(1):43-9.