Oral Swabs

Policy Statement
Number 13
July 2003

The development of Oral Swabs for toxicology testing shows potential in providing an alternative means to test for drug use and to assess if a patient is taking their medication as prescribed. Such advances in technology should improve the quality of treatment that programs can provide to patients.

However until Oral Swabs have been used for a period of time NAMA urges caution in interpreting the results. No test is infallible and reducing the number of false negatives will usually increase the likelihood of false positives. ⁽¹⁾

In discussions with Bendiner and Schlesinger ⁽²⁾ NAMA was informed that any patient having a false positive could have the specimen tested by the more accurate spectrometry technology. Thus patients will have a secondary method by which to test any questionable specimen.

Several instances have occurred in what appears to be a number of false positive specimens using Oral Swabs have been reported to NAMA. In these cases NAMA advises programs to use common sense and that the patient’s welfare should be paramount. Programs need to learn to trust the patient. While this is should be program policy for all patients it should be especially adhered to if the patient has a stable and productive lifestyle, complies with program policy and shows no outward symptoms of drugs use. These suspicious toxicology specimens should be written off and a memo placed in the patient’s record stating that the results of the test are believed to be a false negative. One procedure is to place the patient on weekly toxicology testing for a period of three months and if all the tests are negative then the counselor writes a report stating that the test was in all probability a false positive.

Using new technologies to foster the “Gots-Ya” attitude that programs often take without serious reflection about their impact on patients is not productive. And this is not the kind of treatment that programs need to move toward. While many program staff are familiar with Drs. Dole and Nyswander they really know very little about how there program operated. The primary atmosphere of the their program was compassion and understanding and because of this patients responded positively to being treated as citizens and human beings. Insuring that technology is used for improved methadone patient treatment will require creative program administrators and a focus on providing the patient with quality treatment with dignity and respect.

An End to Demeaning Policies

Oral Swab technology may also begin ending the demeaning practices that programs have created to ensure that proper specimens are obtained. Namely, observed urine testing that created distrust between patients and staff especially counselors. These policies have been implemented because many methadone professionals have not developed the expertise to make proper clinical judgments. They have been trained in programs whose policies are based on the “Philosophy of No” and the “Penal Attitude”. Thus when they err in their decision-making – which is often, they are not able to realize that they are the problem and thus blame their poor decision process on patients.

While Oral Swabs will not end the problems of ignorance and lack of expertise displayed by many professionals they can help to reduce the degrading policies that programs have initiated to collect accurate urine specimens.

Patient’s Procedure to Reverse a Positive Specimen

This procedure is used in many programs to reverse a positive urine specimen.

• The patient should immediately indicate that something is wrong with the specimen and that this should be noted in their patient record.
• Request weekly urine tests for three months or twelve (12) specimens. And that if all the tests are negative for drug use that their counselor write a report indicating the procedure used and that in their expertise that they believe the test was a false positive.

This procedure protects both the program and the patient should future issues emerge regarding the patient, program or laboratory.

Summary

The new technologies emerging show promise in reducing error rates and in providing an alternative means to assess patient progress. Programs should be in the business of building self worth however many programs have implemented degrading policies to collect accurate urine specimens that foster low self esteem. Unfortunately these policies often have a far-reaching impact on the program and damage any ability of program staff to build a therapeutic alliance with the patient.

While NAMA urges caution in embracing anything until the full impact on quality treatment can be assessed, however as advances in technology show promise in improving the quality of treatment that programs can provide to patients.

Notes

1. In New York a laboratory was discovered that was disposing of urine specimens without testing and writing down false result. Patients with twenty years of stability were informed of numerous positive urine specimens resulting in their loss of take home medication. While some clinics reinstated patients that lost there take home medication most clinics did not go back through patient records to set the records straight.

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2. Bendiner and Schlesinger is the distributor of the Oral Swab. Information about it may be obtained by writing to them at 47 Third Avenue, NY, NY 10003.

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