| Overview
Every client receiving methadone treatment
is required to submit a urine specimen for
drug screening on a schedule consistent
with state and Federal regulations. Drug
screening procedures for methadone clients
should be utilized as a treatment tool with
a frequency that is appropriate to individual
clients and adheres to state and Federal
guidelines. Drug screening is conducted
in a respectful manner to clients, utilizing
safe medical practices, and is done in such
a manner as to minimize false results. Analysis
of results should occur and be shared with
clients. Drug testing is not a sole means
to treatment decision-making.
Accreditation Requirement(s)
To be in conformance with this accreditation
standard, the organization must show evidence
of the following:
- An individualized approach to drug
screening is utilized by the program.
- Frequency of testing is based on the
needs of the individual, as well as in
conformance with applicable state and
Federal regulations.
- For each person receiving methadone
or LAAM, there are at least eight drug
screens conducted per year that includes
testing for methadone, opiates, and other
drugs as determined by community standards.
- The collection of samples is done in
a respectful manner, utilizing medically
oriented specimen handling procedures.
- There are policies and procedures to
minimize falsification during the drug
screening collection.
- Drug screening results should not be
used as the only basis for treatment decision-making,
including termination from treatment.
- Drug test results are addressed with
the client as a treatment tool, and they
are documented in the client's medical
record.
- Drug test results are reviewed for
false negative results and false positive
results.
Implementation Tips
Some Implementation Tips provided, in part, by Robert Johnson at: www.accreditationnow.com.
- A urine drug screen refers to the process
where an individual's urine sample is
chemically analyzed for the detection
of certain drugs.
- Per Technical Assistance Publication
#7 (TAP #7), Treatment of Opiate Addiction
with Methadone, A Counselor's Manual,
"Urine testing allows several things.
It enables the program to determine whether
a patient has methadone in his or her
system. Testing is a deterrent to methadone
diversion, and it also may uncover use
of illicit or unauthorized drugs. Most
importantly, however, testing provides
the patient with an additional tool to
prevent drug use" (p. 25).
- The CSAT Guidelines for the Accreditation
of Opioid Treatment Programs (1998)
emphasizes that methadone treatment programs
need to change the way they do business
in terms of drug screening procedures.
Although every client receiving methadone
treatment is required to submit to urine
testing for drug screening, urine specimens
do not all need to be collected in the
same manner or in the same time frame
for each client.
- An "individualized approach"
means that not all clients receive the
same "cookie cutter" number
and types of urine drug screens, which
have been common practice at methadone
clinics in the past. Frequency of drug
screens (other than adherence to the state
and Federal laws) and methods of drug
screening (observed versus unobserved,
the utilization of new technology) should
be dependent on the individual's status
in the program and movement toward recovery.
- Using a respectful manner to collect
urine specimens means that not all of
those specimens need to be collected via
direct observation, video cameras, and
one-way mirrors. This approach is not
warranted for all clients, especially
those who have been in treatment for a
long time, who have earned take-home status,
and who have progressed in their personal
recovery.
- Merely having a positive urine test
for opiates is not a reason to terminate
a person from the program. Instead, clinics
should review the results with their clients,
use the results as a treatment tool for
motivating the clients regarding their
drug use, or perhaps for raising the current
dosage of methadone the clients are receiving.
- Some programs are using innovative,
less invasive technology for drug screening.
"Pass Point" is one such system
that monitors a person's drug use via
eye scans after receiving a baseline reading
from one clean urinalysis.
- All urine test results should be documented
in the client's medical record. The actual
reports from the laboratory are filed
in the medical record. If the program
does not have a consolidated medical/clinical
record but still uses two records per
client (a medical and a clinical record),
methods should be adopted to "notify"
the second record of the urinanalysis
results.
- Universal precautions should be followed
when handling urine specimens. Staff members
should wear gloves when handling urine
cups, per the organization's infection
control policy and/or plan. OSHA guidelines
should be followed in the event of spills.
- Urine testing results are reported
as positive or negative for the presence
of a drug. Laboratory errors can occur,
and sometimes, medical conditions can
interfere with the test results. Results
and their interpretations as per TAP
#7: Treatment of Opiate Addiction with
Methadone, A Counselor's Manual (p.
25) include the following:
- Negative for methadone and methadone
metabolite means that the client has
not taken methadone within/ about
3 days of the test.
- Positive for methadone only means
there is methadone present in the
specimen but not methadone metabolite.
This suggests that some methadone
was put into the urine specimen of
a person who had not been on methadone
and the client is using another person's
urine for the specimen.
- Positive for methadone metabolite
only means that the client didn't
ingest his or her dose the previous
day or that the client is on a very
low dose.
- Positive for methadone and methadone
metabolite means the client is taking
his or her methadone and did take
his or her dose the day before.
- Positive for morphine indicates
that the client is likely using heroin.
|
