Urine analysis (UA) testing can be an essential component of treatment for opioid use disorder (OUD). New research suggests that it's even possible to use remote urinalysis for successful treatment, and that it's a sustainable and feasible way to help patients remain accountable to their care plan. This is promising news for those who don't have easy access to in-person care.
Learn more about how urinalysis for OUD treatment works below.
What is a urinalysis?
There are two types of urine drug screens (UDS). One, immunoassay, is affordable and fast. However, it can't detect all opioids and can give false positives, indicating the presence of a drug even when there was no use.
The other type of test, gas chromatography/mass spectrometry (GC/MS), is pricier and takes longer, but is less likely to produce a false positive. If an immunoassay test is thought to have a false positive, a GC/MS test may be used as a backup.
What does a urinalysis test for? It depends on the context. Traditionally, a UDS analyzes urine for the presence of specified medications or narcotics. This could include amphetamines, cocaine, benzodiazepines, barbiturates, marijuana, methamphetamines, methadone, PCP, or opioids.
The role of urinalysis in OUD treatment
In the case of OUD treatment, a urinalysis can be used to screen for the presence of substances that should not be in the patient's urine, such as opioids. It can also be used to test for the presence of substances that should be in the patient's urine, such as buprenorphine.
Buprenorphine is an essential component in Suboxone® (important safety information), a combination medication that is commonly used to treat OUD. Buprenorphine works by activating the brain's opioid receptors, which helps to reduce withdrawal symptoms and cravings for opioids.
Suboxone may be prescribed as part of a medications for addiction treatment (MAT) plan. With MAT, patients are given mental health support to address the mental component of addiction and also prescribed medication to address the physical component of addiction. If a patient has been prescribed Suboxone, buprenorphine levels in urine tests can confirm that they are taking their medication as intended.
Urinalysis as a rehabilitative solution
There is a common stereotype that UA testing is meant to be a punitive measure. You may have heard of people being obligated to take drug tests because of a legal case, such as drug-related criminal charges or as part of probation. Some employers may also request their employees to take drug tests, particularly in fields like healthcare, transportation, and government.
However, UA testing doesn't have to be punitive. In fact, it can be helpful to people who are undergoing OUD treatment. At Ophelia, UA testing takes a patient-centered rather than a punitive approach. It's seen as a tool, not a form of punishment. There is flexibility around how clinicians and patients choose to use UA testing and the program doesn't discharge patients because UA testing shows they've used any type of substance, including opioids.
How Ophelia incorporates UA testing in telehealth
It's not just the rehabilitative approach that sets apart Ophelia's approach to UA testing. Ophelia is a provider of telehealth-based opioid treatment (TBOT). It works remotely without requiring an in-person presence. Eligible patients can have a Suboxone prescription called into their local pharmacy while receiving mental health support online.
Is TBOT just as effective as in-person treatment? Peer-reviewed research from Ophelia clinicians published in JAMA Health Forum, a top global health-policy journal, affirms the validity of distance treatment—specifically of the use of UA testing as part of treatment.
In the study, which surveyed 3,395 real-world patients, researchers assessed whether routine UA testing could be adapted to TBOT initiatives. For the purposes of the study, participating patients were sent two 16-panel UDS kids. Additional UDS kits were sent throughout treatment, so patients always had at least one kit on hand.
Quality checks via video chat with a clinician helped ensure testing reliability, with patients peeling off the results label live during the video appointment. Temperature strips and creatinine checks helped ensure a specimen was legitimate and that the tested specimen matched the in-person laboratory specimen.
The research found that urine drug testing was both feasible and sustainable throughout tele-treatment. Nearly 100% of patients tested positive for buprenorphine in their urine in the first month of induction. Further, subsequent tests over time showed that buprenorphine positivity increased, while opioid positivity declined.
Ultimately, researchers concluded that urine drug testing is possible to do regularly in remote settings. In the study, patients completed around three and a half drug tests on average during their first six months of treatment. This suggests that remote testing can be used to promote accountability in the long term.
Why remote UA testing matters
Medications for addiction treatment (MAT) is considered the gold standard of care for OUD. However, patients in rural areas may struggle to get care, with numerous studies suggesting geographic barriers to MAT access. Inpatient treatment isn't always possible for individuals who have jobs to hold down or families to care for. This also leads to disparities in care; for example, women may hesitate to seek help because they must prioritize the care of an infant or elder.
By making MAT available online, Ophelia makes OUD treatment more accessible to such patients. Telemedicine can also allow for more discrete treatment, further removing potential emotional and mental barriers to care.
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