Flushing, pale-colored urines, and false negatives. Urinalysis of narcotic addicts

Detected heroin use in an Australian methadone maintenance program

A reanalysis was undertaken of survey and retrospective urinalysis data on patients remaining in an abstinence-oriented, public methadone maintenance program in Sydney, Australia. A comparison of urinalysis results with those of previous reports of Australian methadone programs suggests that the clinic's disciplinary program failed to reduce detected heroin use; morphine was detected in 27% of urine specimens. Women, those with a partner in methadone maintenance, and exprisoners were significantly more likely to submit morphine positive urines. When account was taken of subjects' General Health Questionnaire scores in a second logistic regression model, the more psychologically disturbed patients were one fifth as likely to submit a morphine positive specimen as the less disturbed. This and other findings are interpreted as indicating that psychologically disturbed patients who continued to use heroin were more likely to be expelled from or otherwise leave treatment than the less psychologically disturbed who continued to use heroin.

The Accuracy of Drug Use Monitoring in Methadone Treatment

Patients' urinalysis results are used in methadone maintenance programs to help make decisions about methadone dosage, medication take-home privileges, referrals for employment and job training and detoxification from methadone. Little systematic research exists, however, addressing the adequacy of the procedures used to detect illicit drug use. This study examined the accuracy of patients' clinic thin-layer chromatography (TLC) urinalysis profiles by comparing these with two independent measures of drug use; patient self-reports of drug use and urinalysis using a more sensitive test, enzyme immunoassay (EMIT). A representative sample of 229 patients in three methadone clinics was studied. The study found that drug use as measured by self-reports or by EMIT is 2.5 times higher than use as measured by TLC. The level of agreement between self-reports and EMIT was high, while the levels of agreement between these measures and clinic TLC urinalysis were low. Clinic decisions about take-home medication were shown to be correlated with clinic urinalysis results. The study examines the causes and consequences of inaccurate drug screening and discusses possible alternative responses to the problem for the methadone treatment field.