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Part 2: Process of Drug Testing in
Addiction Treatment
Choosing a Test
Clinical Necessity and Value
Î Before choosing the type of test and matrix, providers should
determine the questions they are seeking to answer and familiarize
themselves with the benefits and limitations of each test and matrix.
Î Test selections should be individualized based on specific patients
and clinical scenarios.
• Patients' self-reported substance use can help guide test selection.
Identifying Substance(s) of Interest
Î Drug testing panels should be based on the patient's drug of choice,
prescribed medications, and drugs commonly used in the patient's
geographic location and peer group.
Î Addiction treatment programs/providers should establish a routine
immunoassay panel.
• Providers should not rely on the NIDA 5 (also known as the SAMHSA 5) as a
routine drug panel.
Î Test panels should be regularly updated based on changes in local and
national substance use trends. Providers should collaborate with the
testing laboratory when determining the preferred test selections to
obtain information about local and demographic trends in substance
use.
Matrix Advantages and Disadvantages
Î Providers should understand the advantages and disadvantages of
each matrix before considering rotational strategies.
Î If a particular specimen cannot be collected (e.g., due to baldness,
dry mouth, shy bladder), providers should consider collecting an
alternative specimen.
Î If a given sample is likely to be prone to confounds, providers should
choose an alternative matrix. For example, heavily chemically treated
hair is not appropriate for drug testing.
Presumptive and Definitive Tests
Î Presumptive testing should be a routine part of initial and ongoing
patient assessment.
Î Presumptive testing should be used when it is a priority to have more
immediate (although less accurate) results.
Î Providers should know the cutoff threshold concentrations that their
laboratory uses when interpreting a report of "no drug present."
