drug testing vial (1688 × 1125)

A contentious debate surrounds the question “Does drug testing work?” There are many reasons this debate is raging throughout our country including socio-economic issues, political leanings, and addiction coming to the forefront again with the opioid epidemic. Personally, I can only credibly add a psychological or mental health professional approach to this question. However, I think there is a flaw in the question itself because we have not consistently defined what “work” really means.

If by “work” we mean that drug testing discourages people in active addiction or recovery from abusing the substance entirely, then according to some studies the answer might be no. If we instead shift our definition of ‘work’ to mean providing systems of prevention and accountability that assist Primary Care Physicians and Substance Abuse Disorder patients in the recovery process, then that answer changes to a likely yes, it does work. In this way, drug testing can be seen as an upstream approach to healthcare overall, by providing an early means of prevention or detecting a “use” event in time to intervene.

 

Drug testing in recovery and addiction treatment

The addiction and recovery world often has a love/hate relationship with drug testing. For those in recovery, drug testing is sometimes seen as a nuisance; an activity that takes precious time away from more “important” priorities but is required by probation officers, employers, and/or family members. After all, in their view, they are in the process of bettering themselves through a recovery program. Others in recovery see drug testing as an important accountability check and safety net. Maybe most importantly, a “clean” drug test provides a powerful way to build trust with family members, friends, and other interested third parties.

Whether one experiences a love or hate relationship with drug testing, showing up for and passing a drug test is an important indicator of the strength and status of a person’s recovery. There are many types of tests available (e.g., blood, saliva, hair follicle, urine) but given the prevalence of collection sites across the country and the potential insurance coverage available, urine drug screening is a cost-effective, accurate, and objective measure of a person’s recovery.

 

Experts say drug screening is medically necessary

The American Society of Addiction Medicine (ASAM, 2010) endorses drug testing as a “key diagnostic and therapeutic tool that is useful for patient care and in monitoring the ongoing status of a person who has been treated for addiction.” ASAM goes so far as to state that the number of tests and the frequency and complexity of tests should be left to a doctor’s assessment with no arbitrary limits on reimbursement. In fact, such limits on drug testing are discriminatory and prohibited by federal mental health and addiction parity legislation (ASAM, 2010). This is indicative of the essential role that drug testing plays in the overall wellness and progress of those in recovery from addiction.

Post-treatment monitoring ought to be conducted by physicians and treatment teams, by giving medical professionals the authority to determine the frequency and duration of testing based on individual need rather than cost. In this light, addiction is seen as the brain disease that it is and treated in parallel terms with other diseases that require ongoing monitoring such as diabetes, lupus, cancer, and other chronic and recurring illnesses.

Similarly, the National Institute on Drug Abuse (NIDA, 2012) advocates that people in recovery must be monitored continuously, as lapses in treatment occur. In their research publication, Principles of Drug Addiction Treatment*, the experts at NIDA state:

“Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.”

Some have suggested that drug testing may be a matter of life and death because we are in the midst of an opioid epidemic. According to the Department of Health and Human Services:

Our nation is in the midst of an unprecedented opioid epidemic. More people died from drug overdoses in 2014 than in any year on record, and the majority of drug overdose deaths (more than six out of ten) involved an opioid. Since 1999, the rate of overdose deaths involving opioids—including prescription opioid pain relievers and heroin—nearly quadrupled, and over 165,000 people have died from prescription opioid overdoses (HHS).

 

Does drug testing reduce the misuse of opioids?

Unfortunately, the research on drug testing for those who misuse opioids for chronic pain is not encouraging. Dr. Joanna Starrels (2010) and colleagues at the Albert Einstein College of Medicine and Montefiore Medical Center in New York, conducted a review of 11 studies and examined the impact of drug testing on opioid misuse for those suffering from chronic pain. Based on the synthesis and combined studies examined, they concluded that there is “weak evidence” that urine drug testing, as well as treatment agreements, reduces opioid abuse, dependence, or addiction.

These findings may speak to the power of prescription opioids to induce abuse and dependency patterns which often turn into an addiction. Although drug testing does not reduce the prevalence of misuse, it can provide powerful diagnostic evidence that there is a problem, and also be an early detection of a “use” event for those in recovery from opioid addiction.

Despite these findings regarding the misuse of opioids, early detection of a “use” event for those in recovery—particularly between the initial 12 to 18 months—is critical. During this time, people in recovery need others to,

  1. be made aware of the use event and,
  2. intervene appropriately.

Only when a “use” event is known by others and brought to light can appropriate intervention(s) be employed. This detection and early intervention after a “use” event provided by the results of effective drug test saves resources and, more importantly, may save lives.

 

Drug testing helps the patient and the community

Maybe most important is the systemic impact on drug testing for individuals, families, and communities. The act of consistent urine drug testing can have a positive influence on the healing and personal development of those in recovery and their family members. This healing and overall development benefits to our communities and nation as the disease of addiction—the opioid epidemic—takes a terrible toll on our collective psychology, resources, and lives.

For those in recovery desperate to rebuild trust with their loved ones, drug testing offers a means by which they can provide proof to the world they are in recovery and moving forward. Most people in recovery are eager to show others they can be trusted and are living lives of integrity and purpose; drug testing offers an objective way to confirm their successful efforts. Persons in recovery are also keen to escape the overbearing and overwhelming pressure they often feel from family members who are understandably anxious and fearful of post-treatment relapse. A clean drug test helps to alleviate fear and anxiety experienced by family members as they begin to trust the recovery process is working.


References
1. American Society of Addiction Medicine (ASAM, July 1, 2002; rev. October 1, 2010). Drug Testing As A Component Of Addiction Treatment and Monitoring Programs and in Other Clinical Settings. Public Policy Statement on Drug Testing as a Component of Addiction Treatment and Monitoring Programs and in other Clinical Settings.
2. Health and Human Services. The Opioid Epidemics by the Numbers. https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf
3. National Institute on Drug Abuse (2012). Principles of Drug Addiction Treatment: A researched-based guide (Third Edition). NIH Publication No. 12–4180, Printed October 1999; Reprinted July 2000, February 2008; Revised April; December 2012. http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
4. Starrels, J.L., Becker, W.C., Alford, D.P., Kapoor, A., Williams, R., & Turner, B. (2010). Systemic review: Treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Annals of Internal Medicine, 152 (11), 712-720.

*An updated version of Principles of Drug Addiction Treatment can be found here.

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