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Embarrassing, degrading, or beneficial: Patient and staff perspectives on urine drug testing in methadone maintenance treatment

Urine drug testing is a routine, but debated and contentious procedure in methadone maintenance treatment (MMT). Largely overlooked in the debate are the perspectives of patients and clinical staff about this procedure. Using semi-structured interviews (n = 64) with MMT patients and clinical staff at four programmes, we explore their attitudes and perceived implications for treatment. We documented varied urinalysis practices by site and with considerable disagreement regarding its emotional impact and therapeutic value. Among patients, comments about urine drug testing varied from degrading to ambivalence to acceptance as a necessary component of treatment. Staff members who supported urinalysis and described it as beneficial stated that it provided a point of entry into patients' lives and helped to identify possible barriers to recovery. Others believed urinalysis impeded the development and maintenance of an effective therapeutic alliance. Lack of strong empirical evidence demonstrating improved patient outcome related to urine drug testing suggests that this procedure should be determined based on individual patient goals.