Get access

Witnessed versus Unwitnessed Random Urine Tests in the Treatment of Opioid Dependence

Authors

  • Ashok Mallya MD,

    1. The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, Missouri
    Search for more papers by this author
  • Amanda L. Purnell PhD,

    1. The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, Missouri
    Search for more papers by this author
  • Dragan M. Svrakic MD,

    1. The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, Missouri
    2. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
    Search for more papers by this author
  • Ann M. Lovell MSW,

    1. The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, Missouri
    Search for more papers by this author
  • Kenneth E. Freedland PhD,

    1. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
    Search for more papers by this author
  • Britt M. Gott MS,

    1. The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, Missouri
    2. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
    Search for more papers by this author
  • Gregory S. Sayuk MD,

    1. The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, Missouri
    2. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
    3. Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
    Search for more papers by this author
  • Theodore J. Cicero PhD,

    1. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
    Search for more papers by this author
  • Peter A. Brawer PhD,

    1. The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, Missouri
    2. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
    Search for more papers by this author
  • Jodie A. Trafton PhD,

    1. VA Palo Alto Health Care System, Palo Alto, California
    Search for more papers by this author
  • Jeffrey F. Scherrer PhD,

    1. The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, Missouri
    2. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
    Search for more papers by this author
  • Patrick J. Lustman PhD

    Corresponding author
    1. Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
    • The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, Missouri
    Search for more papers by this author

Address correspondence to Dr. Lustman, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid, Medical Box 8134, St. Louis, MO 63110. E-mail: patrick.lustman@va.gov.

Abstract

Background and Objectives

Clinics licensed to provide pharmacotherapy for opiate dependence disorder are required to perform random urine drug screen (RUDS) tests. The results provide the empirical basis of individual treatment and programmatic effectiveness, and public health policy. Patients consent to witnessed testing but most tests are unwitnessed. The purpose of the present study was to compare treatment effectiveness estimates derived from witnessed versus unwitnessed urine samples.

Methods

We adopted a policy requiring visually witnessed urine drug screens (WUDS) and studied its impact (a single group, pretest–posttest design) on the RUDS test results in 115 male veterans enrolled in the St. Louis VA Opioid Treatment Program.

Results

The percentage of opioid-positive urine samples increased significantly following implementation of WUDS (25% vs. 41%, χ2 = 66.5, p < .001).

Conclusions and Scientific Significance

Results of this preliminary study suggest that random testing alone does not ensure the integrity of UDS testing. Outcome calculations based on random unwitnessed tests may overestimate the effectiveness of opioid dependence disorder treatment. (Am J Addict 2013;22:175-177)

Ancillary