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Part 4: Biological Matrices
Î Urine testing is helpful when assessing opioid use.
• Particular caution should be paid to the interpretation of opiate immunoassays due
to known limitations in specificity.
• Patients should be instructed to avoid the consumption of food items that contain
poppy seeds because they can result in a positive opiate test.
Î Urine testing is helpful when assessing cannabis use, although it
is difficult to determine the timing or cessation of consumption in
chronic users due to extended windows of detection for THC.
Blood
Î The relevance of blood testing in addiction treatment is limited mostly
to emergency situations where there is a need to assess intoxication
or impairment.
Breath
Î No statements about the appropriateness of breath testing were
endorsed by the Expert Panel.
Oral Fluid
Î Oral fluid testing is appropriate for presumptive detection of
substance use in addiction treatment settings.
Î Oral fluid collection with a device that facilitates saliva collection is
preferable to expectoration.
Î The creation of a sample for oral fluid testing should be observed.
Î It is recommended that patients abstain from eating for 15–60
minutes prior to oral fluid sample collection.
Î If a patient recently took a drug by mouth (ingestion or inhalation), it is
recommended to wait ≥2 hours before collecting an oral fluid sample.
Sweat
Î There is insufficient evidence to support the use of sweat testing in
addiction treatment. More research is needed before sweat testing can
be recommended over urine testing in clinical settings.
Hair
Î Hair testing in addiction treatment can detect long-term patterns
of use. Routine use of hair testing is not appropriate for addiction
treatment.
