title: Does urine drug abuse screening help for managing patients? A systematic review.
abstract: BACKGROUND
  In the field of addiction, assessment of psychoactive substance use is a key element. Nevertheless, self-reports and clinical examination underestimate the use of psychoactive substances. The implementation of urine drug screening tests (UDS) should improve this assessment. While the diagnostic value of UDS is well demonstrated, the consequences of carrying out UDS on medical management have not been established. Our aim was to summarize the evidence pertaining to the efficacy of UDS for medical management.
  
  
  METHODS
  A systematic review of clinical trials, quasi-randomized and observational studies was performed using PubMed, Cochrane database of systematic review, Cochrane central register of controlled trials, PsycINFO, National Institute on Drug Abuse, ISI Web of Science. The methodological quality was assessed with the score developed by Starrels et al.; the report quality using the CONSORT and the STROBE checklists. The main outcome was medical management or consequences of management for patients in terms of psychoactive substance consumption and its complications, be they medical, social or professional.
  
  
  RESULTS
  Eight studies met the inclusion criteria: one randomized clinical trial, two quasi-randomized studies, one cohort, and four cross-sectional studies. The methodological quality was judged to be poor, with the exception of the randomized clinical trial (fair quality). The value of UDS in managing patients was not clearly indicated in these studies.
  
  
  CONCLUSIONS
  Few studies, with poor quality, have assessed the value of UDS in managing patients using psychoactive substances; though with insufficiency to demonstrate the interest of carrying out UDS. Therefore, pragmatic intervention studies are necessary.
authors.affiliation: Département Universitaire de Médecine Générale, Université de Toulouse; Faculté de Médecine, 133 route de Narbonne, 31063 Toulouse, France; Inserm UMR1027, Université de Toulouse III; Faculté de Médecine, 37 allées Jules Guesde, 31000 Toulouse, France. Electronic address: julie.dupouy@univ-tlse3.fr.
authors.forename: Julie
authors.initials: J
authors.lastname: Dupouy
authors.affiliation: Inserm UMR1027, Université de Toulouse III; Faculté de Médecine, 37 allées Jules Guesde, 31000 Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mémier
authors.affiliation: Inserm UMR1027, Université de Toulouse III; Faculté de Médecine, 37 allées Jules Guesde, 31000 Toulouse, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Catala
authors.affiliation: Laboratoire de pharmacocinétique et de toxicologie clinique, CHU Toulouse, 33 avenue de Grande Bretagne, 31059 Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Lavit
authors.affiliation: Département Universitaire de Médecine Générale, Université de Toulouse; Faculté de Médecine, 133 route de Narbonne, 31063 Toulouse, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Oustric
authors.affiliation: Inserm UMR1027, Université de Toulouse III; Faculté de Médecine, 37 allées Jules Guesde, 31000 Toulouse, France.
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
mesh_terms: D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D010045:Outpatients; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000534:rehabilitation* / Q000652:urine*; D016896:Treatment Outcome
keywords: Immunoassay; Inpatients; Outpatients; Pain management; Substance abuse detection; Substance related disorders