Drug testing

Odysseus

I have been thinking about this for the past few weeks. When I started in the service urine samples where taken three times a week, then it because two, now due to cash problems it is one.

Now there is scope to use opiates when your only being tested once a week, some people can still get away with using once a week on two samples.

Anyway, I know some people are not interested in samples I know a few GPs that don't bother checking test reports in most cases.

So I wondering those that work with addicts where do you stand with samples; for or against?

I used to believe they where important; however, now the only time I check sample results is if a client is looking to get into a facility that requires a set amount of neg samples.

magicherbs

Important part of the over all process but not the be all and end all.

I felt the rationale of urine testing was to a more objective assessment of patient progress - clear urines - good progress, dirty urines - poor progress, no urines, difficult to assess. The window of detection for opiates is 3-10 days, for 6-am is 24 hours. Codeine and similar will cause 'false positives'.

I think testing once a week for reasonably stable patients is more than sufficient, I don't think it's realistic to suggest a patient will suss out they will test negative on Friday if they smoke on Monday or whatever, so they can keep a regular one day a week heroin addiction.

For new entrants, unstable, once or twice a week (don't think more is needed) is absolutely necessary but remember, the urine tests aren't quantative just qualiative, a girl thats gone from injecting every day to smoking once a week may still give dirty urines but made huge progress.

Odysseus

magicherbs wrote: »

Important part of the over all process but not the be all and end all.

I felt the rationale of urine testing was to a more objective assessment of patient progress - clear urines - good progress, dirty urines - poor progress, no urines, difficult to assess. The window of detection for opiates is 3-10 days, for 6-am is 24 hours. Codeine and similar will cause 'false positives'.

I think testing once a week for reasonably stable patients is more than sufficient, I don't think it's realistic to suggest a patient will suss out they will test negative on Friday if they smoke on Monday or whatever, so they can keep a regular one day a week heroin addiction.

For new entrants, unstable, once or twice a week (don't think more is needed) is absolutely necessary but remember, the urine tests aren't quantative just qualiative, a girl thats gone from injecting every day to smoking once a week may still give dirty urines but made huge progress.

As I said I don't have any time for them now, unless an external agency is looking for information and the patients agrees that they can have it. Common procedure for detox and rehab facilities.

On the using once twice a day and still showing clean a lot of my clients would do this, as well as giving flase samples [though that varies from clinic to clinic]. I'm not saying all clients are doing this; however, I know a significant number are doing so; if not weekly than an a regular enough basis.

I fully agree that urines don't capture the type of progress [which is often significant] you note in your example.

magicherbs

Urine testing would be part of the standard protocol in a methadone treatment centre. A supplementary reason for them is that they make the client/patient/service user professional relationship more honest in the sense that patients won't pretend not to have done heroin tat week because the urine test will show otherwise. So after a 'promotion' to level one in community methadone treatment you should have a patient who won't lie about their drug use.

In the MTc scenario all urines are supervised, and samples will show at the lab if tampered with or diluted.

I think the context of urine samples should be kept in mind, they are not supposed to be legally binding nor presumed to be perfect but by in large reliable. In Gp, the urine kits, the expensive proprietary things, are very quick and easy to use so don't see any reason not to. They are not supervised but will show temperature. Other clues should indicate patient lying and tampering but process isn't secure.

I'm not sure what happens in other treatment centres. N my experience I am dealing with people who genuinely want to get drug free so aren't interested in gaming the system rather than people doing it to satisfy some kind of parole requirement etc.

Odysseus

I work in a clinic myself, though I also see clients that are being treated in the community, this would be on top of those that are totally drug free, CPs, and those using drugs other than opiates.

In my experience with supervised samples it really depends on the clinic and the GA's there; in one clinic where I used to do a few sessions a week one of my clients used to give four other clients a container of her urine which they then used for their test. She did not use any other opiates, she did take a lot of extra methadone though. Yet, in another clinic I worked in the GA's where on the ball and few got bogus samples through.

As I'm sure you know bogus samples and people topping up is common enough, however, that is not to say that all clients are at this. I also see plenty of stable clients who have benefited greatly from MMT, maybe even saved their lives.

magicherbs

In my ather short experience I never came across a case where a sample was proven to be bogus. In fact one of first queries was how they managed to do this. The supervisors were just very vigilant and literally stood in the cubicle. Anyway, I totally accept that the process isn't game proof and maybe there were people cheating unbeknownst to us. However, in the clinic i worked in urine wasn't seen like that. Clean urines did drive a number of 'privileges' such as take always but the attitude wasn't really that judicial, punitive or investigative. They weren't drug tests where people got too fussed about the outcome, I hope you unstandardised what I mean.

Finally, possibly this is a rationalisation, is that urine sampling was another legitimate excuse to bring people back during the week, check up, offer drop in counselling, just an extra monitoring opportunity. Perhaps in Dublin there isn't the scope to do the due to numbers.

With regards to mmt in general, it was interesting because reading the papers from the 80s it was brought out as an adjunct to counselling and other treatment but more and more clinicians started seeing it as 99% of the process. Attendance in my investigations, Ireland and worldwide, is always higher on days methadone scripts are being given compared to just counselling.

Having said that, mtt is a very long process, people on it over a decade. I think it is ard to integrate young addicts back in to community, into courses and ultimately into jobs, when they are tethered to the pharmacy. But the drug is legal, open to abuse and black market sales.

So in some respects, it kinda falls into the same category as a prison stay, not really shown to be therapeutic, not really Shown to affect reoffending, not rehabilitative , but while on it/ in it they are far less damaging to society.

RobFowl

I work in addiction (part time) an find dug testing useful but certainly not he be all. Recent research showed the punitive approach to "dirty" urines was not effective.
Over all the MMT does reduce offending, reduces illicit drug use and reduces transmissable disease.
Bloody hard stuff to come off though. I've one client who's been on it over 20 years now.
Counselling is to my mind the key for those motivated to come off drugs and in patient detox beds are needed in greater numbers.
The rule of thirds apply, 1/3 do well, 1/3 keep on using drugs albeit at a lower level sually and 1/3 turn to drink instead..
The occasional sucess story you see though makes the scheme worthwhile (IMO).
Ps coming at it form a medical mindset

magicherbs

Having re read the original post I think it's scandalous that urines are being tested but results aren't being checked. Basically nothing to lose by knowing the result, once off isn't as important as the trends. Having said that, another member of staff was responsible for putting results into patient ledger , wasn't well laid out on electronic file well though

Odysseus

magicherbs wrote: »

Having re read the original post I think it's scandalous that urines are being tested but results aren't being checked. Basically nothing to lose by knowing the result, once off isn't as important as the trends. Having said that, another member of staff was responsible for putting results into patient ledger , wasn't well laid out on electronic file well though

I guess that is where I'm coming from. Those that don't check the results don't believe in testing as such, it not a case of them being to lazy or anything. Now they are in a minority, but they are exist.

I guess I was hoping that there would be a few people who held the same position here, just to try get a better sense of why people hold that position. If we were to stop testing completly it would mean fewer staff would be needed to run a clinic, as you usually have two GA's who are only taking urines at each clinic.


You here some strange things one GP in the community won't leave his office to supervise a sample, he has males fill the bottle in the office. That one seems a bit strange to me:eek:


Any I hope that maks a bit of sense and of course Happy Christmas.

magicherbs

In my limited experience, no direct supervision of any urines in GP - well open to tampering. My previous posts were from perspective of MTC.

I have heard rumbles of shifts towards less frequent urine testing, or random sampling.

I guess it should depend on the reliability of the methadone user in the GP's opinion. So in the context of a single handed GP taking on a methadone patient, he might just randomly urine test and do the supervision rather than never testing because of the time constraints or losing the time by testing weekly with the supervision.

You ask a lad to go out take a piss and you might get the sample back in 30s seconds or 30 minutes you can't run a practice like that.

Odysseus

One thing I forgot to add was it was great to see the positive attitude to counselling and therapy expressed by you both. I sadly do not encounter that to often.

Squeaky the Squirrel

Controversial Surgery for Addiction Burns Away Brain’s Pleasure Center

magicherbs

For the record I think psychological services are extremely under resourced and counselling, psychotherapy, non pharmacological approaches should get greater attention. Having said that I am not yet convinced that the regulations of these services is up to scratch. I do not have a high level of confidence in the quality of these therapists despite most members and their organisations saying otherwise.

Relating to addiction, I feel that attitudes to care was more advice and motivation rather than therapeutic. More life coaching then the tackling of underlying issues.

Very intense poly psychological morbidities , paternal neglect, maternal neglect, sex abuse, low self esteem, low cognitive functioning, low iq, antisocial/dissocial personality traits, depression, anxiety, other mood disorders.

Extreme surgical, electrotherapy would not sit well with me and would be very reluctant to offer, or gain consent from patient for this.

magicherbs

Just to clarify. I have similar opinion to personal trainers and fitness instructors. Overall I think the regulating bodies are meaningless and letters and titles irrelevant, you need to judge all practioneers independently. Like therapists most IMO are awful but some are amazing.