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

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