Patient and Provider Perspectives on the Elimination of Urine Drug Testing in Office-Based Addiction Treatment

Within office-based addiction treatment (OBAT) for opioid use disorder, routine urine drug testing (UDT) has been a near-universal practice, despite concerns about increased stigma and limited evidence on improved patient outcomes. During the COVID-19 pandemic, routine UDT was suspended in many settings as care transformed to telehealth, providing an opportunity to explore viewpoints about routine UDT and the implications of its absence.

We explored patient and provider perspectives through qualitative interviews conducted from May 2021 to May 2022 within an urban, low-threshold OBAT program. Semi-structured interview guides and thematic analysis explored opinions on traditional routine UDT and experiences with its discontinuation during the COVID-19 pandemic.

Based on perspectives of 25 patients and 16 providers, we identified three themes regarding routine UDT and its decreased use during the COVID-19 pandemic: (1) the general utility of UDT within traditional models of care, (2) burdens that routine UDT could present to care engagement, and (3) impacts of UDT on trust within patient-provider relationships.

Our findings support the need for reconsideration of routine UDT in OBAT, as well as the needs for improved care standards. Selective use of UDT can be implemented in a patient-centered manner, including offering it upon patient request (eg, for personal "accountability") and discontinuing it when appropriate and to reduce barriers to care. In place of routine UDT, our findings also highlight the need for alternative, non-stigmatizing clinical tools that can support patients and providers within OBAT care settings.