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Abstract
Urine drug testing is a routine, but debated and contentious procedure in methadone maintenance treatment (MMT). Largely overlooked in the debate are the perspectives of patients and clinical staff about this procedure. Using semi-structured interviews (n = 64) with MMT patients and clinical staff at four programmes, we explore their attitudes and perceived implications for treatment. We documented varied urinalysis practices by site and with considerable disagreement regarding its emotional impact and therapeutic value. Among patients, comments about urine drug testing varied from degrading to ambivalence to acceptance as a necessary component of treatment. Staff members who supported urinalysis and described it as beneficial stated that it provided a point of entry into patients' lives and helped to identify possible barriers to recovery. Others believed urinalysis impeded the development and maintenance of an effective therapeutic alliance. Lack of strong empirical evidence demonstrating improved patient outcome related to urine drug testing suggests that this procedure should be determined based on individual patient goals.
Acknowledgements
We are extremely thankful for the participants and their willingness to discuss their experiences and opinions about methadone maintenance treatment. This study was funded by the Ontario HIV Treatment Network. Salary and infrastructure support for Dr Carol Strike were provided by the Ontario Ministry of Health and Long Term Care. The views expressed in this report do not necessarily reflect those of the Ministry.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.