Testing and Treatment – Partners in Recovery

The UK government’s Drug Strategy 2017 published in July includes an objective focused on supporting those with a drug dependence at all stages of their recovery. The strategy highlights the role that drug testing plays in supporting recovery, particularly in two areas. In the report, drug testing on arrest is indicated as a means of referring offenders into treatment at an early stage. The appropriate use of regular testing is also highlighted as one of the tools that treatment providers can use to help build recovery.

After reading the strategy document I was reflecting on my experience of how the drug testing we provide supports treatment professionals in their efforts to guide individuals through recovery, and what information it provides in addition to their own observations? I often find that a testing result that detects the presence of a drug or its metabolite (a positive result) provides the clearest information. It can support a treatment professional’s own observations of a client when they present, or can indicate that a client who is prescribed a substitution therapy is taking their prescribed medication.

I have, however seen instances where a positive result can have a more challenging impact on both the professional and their client. These are usually instances where a client was thought to be progressing well with their treatment and a positive result comes as a bit of a reality check to all involved. Quite often the question will come back, ‘are you sure it’s positive?’. A confirmed positive result cannot be argued with. The evidence stands up for itself. A drug or metabolite has been detected in the sample indicating recent use of the drug. A test result is limited to just being able to provide this information. It can’t help in answering the questions that inevitably follow between professional and client about the circumstances of the recent drug use, but I hope that it does go some way to opening an honest dialogue to deal with ongoing issues.

A surprising negative result often muddies the waters more than a positive result. It can be very frustrating when you are looking for evidence, but don’t find anything. A negative result is simply that – the lack of evidence of drug use. It doesn’t prove that drugs haven’t been taken (since you can’t prove a negative), but it doesn’t provide evidence that they have been taken. I’ve seen this happen where it seems clear that the client has been using drugs, but none have been detected in their sample, or they are undergoing supervised consumption at a local pharmacy of their substitution therapy medication. It is often in these situations where the drug treatment professional must rely on their own judgement, since there is no supporting information from the drug test result. Discussion with the drug worker about the testing strategy has been useful in these situations, and adjustments in the timing and frequency of testing has often helped in providing them with the positive result they need on future occasions to support their own conclusions.

Peter Akrill
Senior Toxicologist

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