Khatri UG, Aronowitz SV. J Subst Abuse Treat. 2021;123:108258. Read full article.

This is a short opinion article written by American clinicians in which they challenge the use of mandatory urine drug screens. As the authors put it these are: “sending a message of mistrust and hierarchy, potentially causing psychological trauma, and incentivising falsification.” They flag the potential impact on the clinician-patient relationship while also recognising that there may be some value in conducting urinary drug screens. They point out that some patients are motivated by them and other agencies do require it as well — such as probation or child services. Obviously, when there is anxiety about diversion there can be benefits too. However, their main challenge is to urine drug screens as an unthinking and unchallenged element of care. 


This systematic review is a welcome reminder that for all the evidence of the benefit of OST there is also a tremendous amount of evidence around the difficulties for people who take OST. For many people the fundamental mechanisms of OST are challenging, and the number one barrier, stigma, is deeply felt. We need to double down on our efforts to breakdown these barriers. It’s not enough just to be advocates for OST and we need to analyse all our processes and procedures. Urine testing is a good example. It is ingrained in services and Covid-19 has helped to shine a critical light on ‘normal’ practice. Certainly, far fewer urine tests have been done where reviews and assessments have been completed by telephone. In addition, I have to acknowledge, and this is a little painful, that I know of clinicians in years gone by (perhaps even now) who have weaponised urine tests and threatened to reduce methadone unless negatives were produced. The article by Khatri and Aronowitz pokes at the complacency that while urine tests are not used coercively in almost all services, there remains a significant downside to them, an undercurrent of power and control, that demands debate. 

Article taken from our latest Clinical Update, edited by Euan Lawson (Editor of the British Journal of General Practice’). To read the full Clinical Update please become an SMMGP Premium Member.