Urine drug testing practices at Opioid Treatment Programs in a large health system, 2018-2025

The COVID-19 public health emergency prompted substantial changes in opioid treatment program (OTP) practices, including expanded methadone take-home dosing and telehealth use. While many of these changes persisted after the emergency period, less is known about how urine drug testing practices were altered and whether any changes were sustained over time.

We examined monthly trends in urine drug testing among patients receiving methadone for opioid use disorder at 112 OTP clinics operated by a large national treatment organization. Administrative electronic medical record data from January 2018 through June 2025 were used to construct patient-level testing measures. A testing event was defined as any day in which a patient received at least one urine drug test. Interrupted time series analyses assessed changes in the level and trend of average monthly testing at the onset of the COVID-19 pandemic in March 2020.

In January 2018, patients were tested 1.13 days a month on average. Testing frequencies increased by 0.003 days per month on average until February 2020 (p = 0.016). In the first two months of the COVID-19 pandemic testing frequency decreased to 1.00-1.02 days per month (about an 11% decline (p = 0.006)). Testing levels returned to pre-pandemic levels by May 2020. They trended slightly downward through the end of the study period and were at 1.14 days on average in June 2025 (p = 0.033).

Urine drug testing frequency modestly decreased during the first months of the COVID-19 pandemic but quickly returned to pre-pandemic levels. This may reflect the fact that urine drug testing regulations for OTPs were not changed as part of broader post-pandemic federal regulatory reforms. Future research should focus on how to best tailor urine drug testing practices to improve patient engagement, safety, and recovery.