Why We Do It:
Drug testing is an important component of every drug-use treatment program and offers a number of benefits for patients:
- Testing is an objective way to show progress toward goals: When a person is working toward any goal, it’s motivating to see results. The long-term results of successful treatment are realized slowly - improved relationships, improved overall health, and improved progress toward other life goals such as career, education, recreational activities, and so on - whereas drug testing is able to show small measurable progress on a much faster timeframe.
- Testing helps maintain accountability: When experiencing a trigger or other temptation to use, sometimes in the moment patients struggle to find a good reason not-to. Long-term goals may be too far away to clearly see how they will be damaged by a slip or relapse. In these cases, the knowledge that a drug test may be performed at any time and reveal evidence of the drug use can be an immediate reason not-to-use. If that small extra motivation can avoid even a single slip, that’s a tremendous benefit to long-term success.
- Testing helps ensure safety: A common component of opioid-use-disorder is difficulty being fully open with others and a tendency to try to hide drug use. This isn’t universal but is common. Knowing this, it’s important for a medical provider who treats opioid-use-disorder to have objective information about how well treatment is working so that it can be adjusted when needed to improve results. Adjustments may be to the medication dose, medication type, treatment setting, support services, frequency of visits, or frequency of prescriptions.
How We Do It:
- Each patient receives several test kits at-a-time to keep them at home in a safe place. The test kits are available for use when a test is requested by your medical provider through the Bicycle Health app. Since accountability depends on knowledge that a test can be performed at any time, the tests are ordered randomly, and your medical provider determines how often they’re ordered but not the exact date.
- When prompted to complete a test it should be done as soon as possible. Since test kits are always on-hand and people tend to pee at least once each day, it’s reasonable to assume tests can be completed same-day with few exceptions. If an ordered test is not completed by the next-day, the delay is considered as a sign of a potential treatment concern like a slip or relapse, and your provider will take steps to improve treatment success. For upcoming vacations, other travel, or other times when a patient knows they’ll be unable to complete a drug screen, we just need notice of the dates of unavailability, and we’ll keep track of those dates and will not ask for a drug screen to be completed during that time.
- Sometimes we ask for a saliva drug screen to be completed during a video-visit with a team member. This is also requested randomly. We compare the saliva results to recent urine results in order to be confident that both samples came from the same person.
- Sometimes we ask for a send-off test or a test collected as a nearby commercial lab like Quest of Labcorp. This type of test allows for sophisticated measurement of the type and amount of buprenorphine present in the sample and can determine the difference between medication taken every day as directed and medication taken only sometimes or only very recently.
What We Do With the Result:
Your medical provider will review each drug test with you and determine if the result supports effective treatment and progress toward goals, or if it suggests room for improvement. A result that supports effective treatment is completed within the required timeframe, has the expected temperature and appearance of a new urine sample, contains the medication that is prescribed, and does not contain drugs that are unexpected or inconsistent with the goals of treatment.
Results that support effective treatment may result in increased treatment flexibility such as longer time periods between visits to the pharmacy, longer time periods between medical provider visits, and eventually fewer drug screens and fewer random medication counts if that’s desirable for you. The maximum amount of flexibility we can provide is a prescription and medical visit every 28-30 days, a random urine drug screen on average every 30 days (or as directed by a clinician), and a random medication count on average once per year.
Results that do not support effective treatment will prompt your provider to look for the cause of the unexpected result and work with you to address it. It will also result in an increase in structure and intensity of treatment. The maximum amount of structure we can provide is a prescription and medical visit every week, a random drug screen on average twice per month, a random medication count on average twice per month, and weekly group or individual therapy sessions either through our own program or referral to an outside program.
Overall, the purpose and focus of the drug screening program is to maximize patient safety and success, and we do our best to help you achieve both.
