title: Witnessed versus unwitnessed random urine tests in the treatment of opioid dependence.
abstract: OBJECTIVE
  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%, χ(2) = 66.5, p < .001).
  
  
  CONCLUSIONS
  Results of this preliminary study suggest that random testing alone does not ensure the integrity of UDS testing. Outcome calculations based on random unwitnessed tests may overestimate the effectiveness of opioid dependence disorder treatment.
authors: The Bell Street Clinic Opioid Treatment Program (OTP), Mental Health Service, John Cochran Hospital, St. Louis VA Medical Center, St. Louis, MO, USA.
authors: Ashok
authors: A
authors: Mallya
authors: Amanda L
authors: AL
authors: Purnell
authors: Dragan M
authors: DM
authors: Svrakic
authors: Ann M
authors: AM
authors: Lovell
authors: Kenneth E
authors: KE
authors: Freedland
authors: Britt M
authors: BM
authors: Gott
authors: Gregory S
authors: GS
authors: Sayuk
authors: Theodore J
authors: TJ
authors: Cicero
authors: Peter A
authors: PA
authors: Brawer
authors: Jodie A
authors: JA
authors: Trafton
authors: Jeffrey F
authors: JF
authors: Scherrer
authors: Patrick J
authors: PJ
authors: Lustman
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011237:Predictive Value of Tests; D015813:Substance Abuse Detection / Q000379:methods*; D016896:Treatment Outcome; D059349:Urine Specimen Collection / Q000379:methods*