Urine Drug Screening (UDS) in the Management of Substance Use Disorders

Urine drug screens can add accountability to a patient’s recovery plan. An upfront discussion of the role of the urine drug screen in treatment is important for a solid provider client therapeutic relationship. Substance use disorders are relapsing and remitting disorders. The goal of treatment is to extend the duration of sobriety until it is life-long, a lifestyle. The role of the urine drug screen in a treatment program should be therapeutic not penalizing. Understanding what a drug screen can and can not do in providing information is important. Using a consistent screen and appropriately certified laboratory is a must. This chapter covers the types of drug screens, the substances identified in a standard urine dug screen and provides guidance on when other substances may need to be requested during screening. Some substances such as “bath salts” are not identified in current urine drug screens. In clinical situations it will be important to confirm any positive results found on a urine drug screen. Common agents and medications that cause false positive or negative results are identified in the chapter. Proper process for obtaining and handling the urine sample including proper chain of custody are presented.

Keywords: Adulteration, Bath salts, Chain of custody, False negative, False positive.