Considering the harms of our habits: The reflexive urine drug screen in opioid use disorder treatment

The COVID-19 pandemic has led to abrupt changes in the delivery of substance use treatment, notably the adoption of telehealth services and a departure from mandatory urine drug screens (UDS). Amid current circumstances, the UDS, which had evolved to signal a “successful” recovery, no longer seems feasible, safe, or necessary. Even prior to the pandemic, the UDS had notable drawbacks, including sending a message of mistrust and hierarchy, potentially causing psychological trauma, and incentivizing falsification. Nonetheless, certain patients may state that they depend on the UDS for motivation or structure while some providers may rely on it to discover which patients are struggling. While a combination of self-report and UDS is generally regarded as the strongest measure of substance use among patients, our experiences caring for patients without the results of the UDS during the COVID-19 pandemic have forced us to examine the use of other measures to define a successful recovery. Complete abstinence may not be the goal for all patients and those who achieve abstinence may have additional goals worth supporting. While the UDS will likely be incorporated back into our treatment plans, we suggest unseating it as the centerpiece of substance use care and discovering additional methods of measuring our patients' outcomes in less traumatizing and more patient-centered ways.