Drug Testing: A White Paper of the American Society of Addiction Medicine (ASAM)
Recognizing that drug testing is vastly underutilized throughout health care, the American Society of Addiction Medicine (ASAM), the nation’s largest organization of physicians specializing in the prevention and treatment of addiction, has produced this White Paper to highlight the wide range of applications in which drug testing can promote prevention, early detection, and lifelong recovery*1 from addiction*2 in the interests of individual and public health. This paper describes the uses of drug testing as a primary prevention, diagnostic, and monitoring tool to identify the presence or absence of drugs of abuse* or therapeutic agents related to addiction management in multiple settings.
Drug tests identify a chemical compound – a “drug”* – in body fluids or tissues. A test is “positive” if the specific compound is present in the sample at a concentration at or above the limit of detection*3 for that compound. The identification of a drug in a drug test provides evidence of exposure to that drug. In many settings drug testing also includes alcohol testing.
This White Paper encourages wider and “smarter” use of drug testing within the practice of medicine and, beyond that, broadly within American society. Smarter drug testing means increased use of random testing* rather than the more common scheduled testing,* and it means testing not only urine but also other matrices such as blood, oral fluid (saliva), hair, nails, sweat and breath when those matrices match the intended assessment process. In addition, smarter testing means testing based upon clinical indication for a broad and rotating panel of drugs rather than only testing for the traditional five-drug panel4 that was designed not by practicing physicians or researchers, but by the federal government for government-mandated testing such as that required of commercial drivers. Smarter testing means improved sample collection and detection technologies to decrease sample adulteration* and substitution.* Designing appropriate steps to respond to the efforts of individuals trying to subvert the testing process must be considered when evaluating the costs/benefit ratio of different testing matrices, recognizing that such countermeasures may have a dramatic impact on the usefulness of testing. Smarter drug testing means careful consideration of the financial costs of testing in relationship to the value and in many cases, medical necessity, of the test results. It means considering the advantages and limitations of the many testing technologies available today.
This White Paper explains the science and current practice of drug testing in various contexts and outlines the ways in which drug testing can be used more effectively in medical practice. We focus on ways that physicians, other health care providers, and others can use drug testing to discourage nonmedical drug use* and diversion* of controlled substances,* to encourage appropriate entry into addiction treatment,* to identify early relapse and to improve outcomes of addiction treatment through the use of long-term post-treatment monitoring.*