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Outpatient Services (1.0) and Intensive Outpatient/
Partial Hospitalization Services (2.0)
Î Because the opportunity for substance use is greater in outpatient
treatment than in more intensive levels of care, drug testing has a
particularly important role in monitoring substance use.
ÎProviders should implement a random unannounced schedule of
testing in outpatient services whenever possible, because the patient's
opportunity for substance use is greater relative to residential treatment.
Î Drug testing should be scheduled on days following weekends,
holidays and paydays when feasible. Providers should communicate
with patients about plans for additional drug tests around events/
special occasions.
Î Additional drug testing should be considered if a patient is
experiencing stressful psychological events.
Residential/Inpatient (3.0) and Medically-Managed
Intensive Inpatient Services (4.0)
Î Drug testing plays an important role in maintaining a drug-free
therapeutic environment in residential treatment.
Î When residents leave the treatment program on passes, they should
be asked to provide a sample for drug testing shortly after their return.
Providers should communicate with patients about plans for additional
drug testing following their return.
Opioid Treatment Services (OTS)
Î The primary purposes of drug testing in the context of OTS are:
a) detecting substance use that could complicate treatment response
and patient management; b) monitoring adherence with the prescribed
medication; and c) monitoring possible diversion.
Î Drug testing can be an important tool for detecting the use of
substances that can be lethal in combination with a prescribed opioid
agonist medication (e.g., benzodiazepines).
Î Drug testing has potential application across all stages of OTS including
pre-induction assessment and treatment planning, active treatment,
and during maintenance and recovery. Providers should utilize drug
testing during the assessment phase and throughout treatment.
• Providers should utilize drug testing as an aspect of contingency management in
OTS.
Î Provider education should include knowledge of the metabolic
pathways of commonly prescribed opioids.
Part 5: Settings
