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. 1988 Sep;149(3):296–303.

Clinical evaluation and use of urine screening for drug abuse.

A J Saxon, D A Calsyn, V M Haver, C J Delaney
PMCID: PMC1026410  PMID: 3176489

Abstract

Urine drug screening is indicated to evaluate patients who show mental status or behavioral changes and to monitor the abstinence of drug abusers. The appropriate timing for collecting urine specimens may vary depending on the suspected drug of abuse and on laboratory factors. Laboratories use a variety of techniques to do urine screens, and these must be understood by clinicians ordering the screens to interpret results correctly. In treating drug-abusing patients, clinicians must apply structured reinforcement in conjunction with urine screen results to aid patients in achieving abstinence.

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Selected References

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  1. Anker A. L., Crowley T. J. Use of contingency contracts in specialty clinics for cocaine abuse. NIDA Res Monogr. 1982 Apr;41:452–459. [PubMed] [Google Scholar]
  2. Black D. L., Goldberger B. A., Caplan Y. H. Enzyme immunoassay method for comprehensive drug screening in micro-samples of urine. Clin Chem. 1987 Mar;33(3):367–371. [PubMed] [Google Scholar]
  3. Calsyn D. A., Saxon A. J. A system for uniform application of contingencies for illicit drug use. J Subst Abuse Treat. 1987;4(1):41–47. doi: 10.1016/0740-5472(87)90009-2. [DOI] [PubMed] [Google Scholar]
  4. Cone E. J., Johnson R. E., Darwin W. D., Yousefnejad D., Mell L. D., Paul B. D., Mitchell J. Passive inhalation of marijuana smoke: urinalysis and room air levels of delta-9-tetrahydrocannabinol. J Anal Toxicol. 1987 May-Jun;11(3):89–96. doi: 10.1093/jat/11.3.89. [DOI] [PubMed] [Google Scholar]
  5. Crowley T. J. Contingency contracting treatment of drug-abusing physicians, nurses, and dentists. NIDA Res Monogr. 1984;46:68–83. [PubMed] [Google Scholar]
  6. DOLE V. P., NYSWANDER M. A MEDICAL TREATMENT FOR DIACETYLMORPHINE (HEROIN) ADDICTION. A CLINICAL TRIAL WITH METHADONE HYDROCHLORIDE. JAMA. 1965 Aug 23;193:646–650. doi: 10.1001/jama.1965.03090080008002. [DOI] [PubMed] [Google Scholar]
  7. Dackis C. A., Pottash A. L., Annitto W., Gold M. S. Persistence of urinary marijuana levels after supervised abstinence. Am J Psychiatry. 1982 Sep;139(9):1196–1198. doi: 10.1176/ajp.139.9.1196. [DOI] [PubMed] [Google Scholar]
  8. Dolan M. P., Black J. L., Penk W. E., Robinowitz R., DeFord H. A. Contracting for treatment termination to reduce illicit drug use among methadone maintenance treatment failures. J Consult Clin Psychol. 1985 Aug;53(4):549–551. doi: 10.1037//0022-006x.53.4.549. [DOI] [PubMed] [Google Scholar]
  9. Frings C. S., White R. M., Battaglia D. J. Status of drugs-of-abuse testing in urine: An AACC study. Clin Chem. 1987 Sep;33(9):1683–1686. [PubMed] [Google Scholar]
  10. Gawin F. H., Kleber H. D. Abstinence symptomatology and psychiatric diagnosis in cocaine abusers. Clinical observations. Arch Gen Psychiatry. 1986 Feb;43(2):107–113. doi: 10.1001/archpsyc.1986.01800020013003. [DOI] [PubMed] [Google Scholar]
  11. Gold M. S., Dackis C. A. Role of the laboratory in the evaluation of suspected drug abuse. J Clin Psychiatry. 1986 Jan;47(1 Suppl):17–23. [PubMed] [Google Scholar]
  12. Goldstein A., Brown B. W., Jr Urine testing schedules in methadone maintenance treatment of heroin addiction. JAMA. 1970 Oct 12;214(2):311–315. [PubMed] [Google Scholar]
  13. Goldstein A., Horns W. H., Hansteen R. W. Is on-site urine testing of therapeutic value in a methadone treatment program? Int J Addict. 1977 Sep;12(6):717–728. doi: 10.3109/10826087709024121. [DOI] [PubMed] [Google Scholar]
  14. Gottheil E., Caddy G. R., Austin D. L. Fallibility of urine drug screens in monitoring methadone programs. JAMA. 1976 Aug 30;236(9):1035–1038. [PubMed] [Google Scholar]
  15. Hansen H. J., Caudill S. P., Boone D. J. Crisis in drug testing. Results of CDC blind study. JAMA. 1985 Apr 26;253(16):2382–2387. [PubMed] [Google Scholar]
  16. Harford R. J., Kleber H. D. Comparative validity of random-interval and fixed-interval urinalysis schedules. Arch Gen Psychiatry. 1978 Mar;35(3):356–359. doi: 10.1001/archpsyc.1978.01770270106010. [DOI] [PubMed] [Google Scholar]
  17. Havassy B., Hall S. Efficacy of urine monitoring in methadone maintenance. Am J Psychiatry. 1981 Nov;138(11):1497–1500. doi: 10.1176/ajp.138.11.1497. [DOI] [PubMed] [Google Scholar]
  18. Higgins S. T., Stitzer M. L., Bigelow G. E., Liebson I. A. Contingent methadone delivery: effects on illicit-opiate use. Drug Alcohol Depend. 1986 Jul;17(4):311–322. doi: 10.1016/0376-8716(86)90080-3. [DOI] [PubMed] [Google Scholar]
  19. Holden C. Doctors square off on employee drug testing. Science. 1987 Nov 6;238(4828):744–745. doi: 10.1126/science.3672121. [DOI] [PubMed] [Google Scholar]
  20. Jatlow P. I., Van Dyke C., Barash P., Byck R. Measurement of benzoylecgonine and cocaine in urine, separation of various cocaine metabolites using reversed-phase high-performance liquid chromatography. J Chromatogr. 1978 May 11;152(1):115–121. doi: 10.1016/s0021-9673(00)85340-6. [DOI] [PubMed] [Google Scholar]
  21. Lund P. K. Urine screening for drug abuse. J Oslo City Hosp. 1984 Nov-Dec;34(11-12):115–122. [PubMed] [Google Scholar]
  22. McBay A. J. Drug-analysis technology--pitfalls and problems of drug testing. Clin Chem. 1987 Oct;33(11 Suppl):33B–40B. [PubMed] [Google Scholar]
  23. McCarthy J. J., Borders O. T. Limit setting on drug abuse in methadone maintenance patients. Am J Psychiatry. 1985 Dec;142(12):1419–1423. doi: 10.1176/ajp.142.12.1419. [DOI] [PubMed] [Google Scholar]
  24. Milby J. B., Clarke C., Toro C., Thornton S., Rickert D. Effectiveness of urine surveillance as an adjunct to outpatient psychotherapy for drug abusers. Int J Addict. 1980 Oct;15(7):993–1001. doi: 10.3109/10826088009040073. [DOI] [PubMed] [Google Scholar]
  25. Morgan J. P. Problems of mass urine screening for misused drugs. J Psychoactive Drugs. 1984 Oct-Dec;16(4):305–317. doi: 10.1080/02791072.1984.10472301. [DOI] [PubMed] [Google Scholar]
  26. Mueller S. M. Neurologic complications of phenylpropanolamine use. Neurology. 1983 May;33(5):650–652. doi: 10.1212/wnl.33.5.650. [DOI] [PubMed] [Google Scholar]
  27. O'Connor J. E., Rejent T. A. EMIT cannabinoid assay: confirmation by RIA and GC/MS. J Anal Toxicol. 1981 Jul-Aug;5(4):168–173. doi: 10.1093/jat/5.4.168. [DOI] [PubMed] [Google Scholar]
  28. Posey B. L., Kimble S. N. High-performance liquid chromatographic study of codeine, norcodeine, and morphine as indicators of codeine ingestion. J Anal Toxicol. 1984 Mar-Apr;8(2):68–74. doi: 10.1093/jat/8.2.68. [DOI] [PubMed] [Google Scholar]
  29. Resnick R. B., Kestenbaum R. S., Schwartz L. K. Acute systemic effects of cocaine in man: a controlled study by intranasal and intravenous routes. Science. 1977 Feb 18;195(4279):696–698. doi: 10.1126/science.841307. [DOI] [PubMed] [Google Scholar]
  30. Stitzer M. L., Bickel W. K., Bigelow G. E., Liebson I. A. Effect of methadone dose contingencies on urinalysis test results of polydrug-abusing methadone-maintenance patients. Drug Alcohol Depend. 1986 Dec;18(4):341–348. doi: 10.1016/0376-8716(86)90097-9. [DOI] [PubMed] [Google Scholar]
  31. Stitzer M. L., Griffiths R. R., McLellan A. T., Grabowski J., Hawthorne J. W. Diazepam use among methadone maintenance patients: patterns and dosages. Drug Alcohol Depend. 1981 Nov;8(3):189–199. doi: 10.1016/0376-8716(81)90061-2. [DOI] [PubMed] [Google Scholar]
  32. Strug D. L., Hunt D. E., Goldsmith D. S., Lipton D. S., Spunt B. Patterns of cocaine use among methadone clients. Int J Addict. 1985 Aug;20(8):1163–1175. doi: 10.3109/10826088509056357. [DOI] [PubMed] [Google Scholar]
  33. Trellis E. S., Smith F. F., Alston D. C., Siassi I. The pitfalls of urine surveillance: the role of research in evaluation and remedy. Addict Behav. 1975 Jul;1(1):83–88. doi: 10.1016/s0306-4603(75)80021-9. [DOI] [PubMed] [Google Scholar]

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