1. Urine Drug Testing Why we do it When we do it How we do it What do we test for Problems & Limitations

2. Why Test? Test to confirm the history of drug use given by the client Provides accountability for the client Provides a way for us to document drug use or abstinence Confirms stability or identifies relapse therefore enhances safety when giving carries

3. When do we test? At admission to the program to document the use of opiate Throughout stabilization to document progress In maintenance phase to document abstinence as part of monitoring stability to allow carries to be given Can identify if ongoing drug use is contributing to persistent difficulties

4. How Often? More frequent e.g.weekly testing while working towards carries Less frequent when stable Ideal would be random testing More practical is testing at apts.

5. How : Sample Collection Take measures to reduce chances of sample dilution, adulteration, or substitution Direct observation? - not at AFM Leave bags, bulky outdoor clothing, empty pockets Designated urine sample collection area - ideally with ‘blued toilet’ & no access to tap water until sample is handed over Temperature strip on bottle

7. Testing Methods Immunoassay - drug class specific –Does not identify individual drugs in each class GC/MS - gas chromatography/mass spectrometry - can identify a specific drug or metabolite Point of care testing is easy & quick but costly

8. Point of care testing

9. What do we test for? Methadone to confirm it’s presence Opiates including oxycontin Cocaine Benzodiazepines Marijuana? Alcohol use is important - but not part of urine drug testing

10. Problems & Limitations “I can’t pee” or I just went “I haven’t used since the last apt but I took a Tylenol #1 for a headache yesterday” Urine is cold - did they bring it with them? Did they dilute it? Urine is negative for everything - including Methadone

11. Problems & Limitations Benzodiazepines & Marijuana persist for several weeks All other drugs only test positive for a few days Oxycontin does not test positive in most opiate immunoassay tests No test for Fentanyl Clonazepam & Alprazolam test negative on immunoassay for benzodiazepines