10 October 2001

Comparison of urine toxicology with self-report.

Chermack ST, Roll J, Reilly M, Davis L, Kilaru U, Grabowski J. Comparison of patient self-report and urinalysis results obtained under naturalistic methadone maintenance conditions. D&A Dependence (2000) 59:43-49

Dear Colleagues,

'Confidential' comparisons of urine testing with self-report outside the clinical setting have shown close accuracy (Darke 1998). However, when responses are given to clinicians in the naturalistic setting, as this study finds, they are less likely to be as accurate, at least this is so in the clinic setting where treatment termination based on such results is possible. It is the experience of most who work in the behavioural area that self report is less accurate than objective findings. This probably applies to weight reduction programs, ("the scales are wrong, doctor"), smoking cessation, etc. Urine toxicology always introduces some tension, just like the scales, but it should never cause treatment to be terminated and *taken alone* such testing should not cause patients' treatment schedules to be altered. The most serious consequence of a positive test should be a counselling visit in which 'punishment' should not be an issue.

Despite the lack of surprise in these overall results, it is always gratifying to have ones own experiences documented in a careful scientific study.

These results are hard to generalise to other practices since the patients were all male, ex-service personel, aged 50.4 years (mean) and three quarters were African American.

These authors use exhaustive statistical analysis comparing urine tests results (EMIT tests for opiates and cocaine) and a structured ASI (addiction severity index) including questions on drug use in the previous 30 days. These showed a degree of concordance, but not nearly as much as previous reports of confidential studies where the information was assured to be kept private from treating doctors. What a remarkable state of affairs when patients are apparently afraid for their own doctor to know more about their case!

Comments by Andrew Byrne ..