ASAM Opioid Addiction Treatment GUIDELINES Apps and Pocket Guides brought to you courtesy of Guideline Central. Enjoy!
Issue link: https://eguideline.guidelinecentral.com/i/840070
18 Part 5: Settings Testing Schedule Î Drug testing frequency is determined by stage of treatment as well as other patient factors and should be individualized. Î Testing should be more frequent during the stabilization period, and less frequent during the maintenance period. Î Drug testing during and after tapering from methadone or buprenorphine continues to be an important way to support a patient's recovery. Providers may want to consider increasing drug testing frequency during tapering and in the period after tapering. Responding to Test Results Î Expected drug test results (i.e., positive for prescribed medication and negative for unexpected substances) should be praised and responded to with tangible contingencies such as take-home doses of medication. Î High concentration of a parent drug in the absence of its metabolites is consistent with sample tampering in the form of post-collection addition of the drug to the sample and potential diversion. In this case, a follow-up assessment should be conducted with the patient. Î A test that is negative for the prescribed medication (e.g., negative for buprenorphine in a patient prescribed buprenorphine) should not be used on its own to determine that diversion is occurring. However, the cause of the test results should still be explored with the patient. Potential scenarios include but are not limited to overuse of medication, incorrect drug test used, or an unfulfilled prescription. Î Unexpected drug test results could indicate the need for one or more of the following responses: 1. a higher level of care 2. a higher dose of medication 3. a different schedule of testing, such as random rather than scheduled and/or more frequent; and/or 4. increased education for the patient. Considerations for OTP Settings Î For patients in OTP settings, the federally mandated "eight tests per year" should be seen as a minimum, and it is often appropriate to perform testing more frequently than eight times per year. Determinations about testing frequency and duration should be made with consideration of individual patients, as noted above. Î For patients in OTP settings, provider response to unexpected test results can include discontinuation or reduction of take home doses of medication, more frequent or random schedule of drug testing, and increased counseling and peer group sessions.