A commentary on “Urine testing in methadone maintenance treatment: applications and limitations”

Abstract

Drs. Goldstein and Brown (2003) raise a number of of methadone maintenance treatment programs (now OTPs) reasonable concerns about the limited drug testing schedule, which is currently required for all opioid treatment programs (OTP) in the United States through the accreditation regulations of the Center for Substance Abuse Treatment (CSAT). These regulations were promulgated during May, 2001, replacing the previous process-oriented Food and Drug Administration regulations for methadone treatment programs. The article clearly notes that ‘‘the currently mandated eight tests per year per patient in maintenance treatment will almost never detect a skipped dose or ‘dirty’ urine for a given patient unless such events are occurring very frequently.’’ Aside from the fact that OTPs need to eliminate the pejorative use of terms such as ‘‘dirty urine,’’ which is inferred by the authors through quotation marks, the statement reflects a reality. The point is that eight drug tests per annum is inadequate in terms of trying to accurately determine if an individual patient within an OTP is abusing or even using alcohol or other drugs. Through analysis and arithmetic calculation, the Goldstein/Brown article concludes that such drug tests cannot be collected on a randomized schedule since ‘‘a patient may correctly anticipate that once a urine specimen has been obtained in a certain calendar month, no further specimen will be called for until the next month’’, provided that the OTP follows the minimum standard. A number of administrators and clinicians anticipated such difficulties in writing the State Methadone Treatment Guidelines, which was the first Treatment Improvement Protocol (TIP) published by CSAT in 1993. It was determined by the crafters of the guidelines that a full chapter needed to be devoted to the topic of ‘‘Urinalysis as a Clinical Tool’’ and Ira Marion was invited to write the chapter. Mr. Marion’s introduction makes the point quite clearly. ‘‘The screening of urine specimens for the presence of methadone and drugs of abuse has been an integral part