Tuesday, June 28, 2005

drug testing - process v. purpose

Urine toxicology tests for methadone maintenance patients (but apparently not for buprenorphine patients) is a universal practice, and generally continues for even the most stable patients who have been in treatment for decades. To minimize likelihood of "cheating" many programs directly observe the act of urination, or use closed circuit video monitors, test for temperature, etc. To accommodate those who consider these techniques to be undignified, different testing approaches have been introduced over the years: hair samples, saliva specimens, "markers" given to patients before testing that can be identified in the urine specimens, etc. The use to which the test results are put will determine whether and at what lengths steps are needed to lessen the likelihood of "cheating". The more heroic measures to counter patient deception will be employed by those providers who impose the greatest "punishment" for positive toxicology results: reduced "take-home privileges," reduced dosage (despite the illogic of such a response), termination of treatment (and incarceration for patients under some kind of criminal justice system order), etc .

QUESTION: is the challenge the enhanceent of the PROCESS of specimen collection and testing, or is it the need to reconsider the PURPOSE of testing?

And whatever the rationale used to justify on-going testing of all patients, would the same rationale perhaps suggest that every caregiver - doctor, nurse, "counselor" etc - also be tested under identical conditions and, where relevant, with the same consequences (e.g., terminaiton from the program or the practice)?

Bottom line: does the field of addiction treatment need a better mousetrap, or should it be reconsidering just why it is so intent to catch mice in the first place? COMMENTS WELCOME.


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