The Accuracy of Drug Use Monitoring in Methadone Treatment

• Author: Stephen Magura,Douglas S. Lipton
• DOI: 10.1177/002204268801800302
• Date: 01 July 1988
• Published date: 01 July 1988
• Subject Matter: Article

The Journal of Drug Issues, 18(3),317-326, 1988

THE

ACCURACY

OF

DRUG

USE

MONITORING

IN

METHADONE TREATMENT

Stephen

Magura

Douglas

S.

Lipton

Patients' urinalysis results are used in methadone

maintenance programs to help make decisions about

methadone dosage, medication take-home privileges,

referrals for employment

andjob

training

and

detox-

ification from methadone. Little systematic research

exists, however, addressing the adequacy

of

the pro-

cedures used to detect illicit drug use. This study

examined the accuracy

of

patients' clinic thin-layer

chromatography (TLC) urinalysis profiles by com-

paring these with two independent measures

of

drug

use; patient self-reports

of

drug use

and

urinalysis

using a more sensitive test, enzyme immunoassay

(EMIT). A representative sample

of

229

patients in

three methadone clinics was studied. The

study

found that drug use as measured by self-reports or by

EMIT

is 2.5 times higher than use as measured by

TLC. The level

of

agreement between self-reports

and

EMIT

was high, while the levels

of

agreement be-

tween these measures

and

clinic TLC urinalysis were

low. Clinic decisions about take-home medication

were shown to be correlated with clinic urinalysis

results. The study examines the causes

and

conse-

quences

of

inaccurate drug screening

and

discusses

possible alternative responses to the problem for the

methadone treatment field.

~~rhen

MalrUra. Ph.D., is a Senior Project Director at Narcotic and Drug Research, Inc., 11Beach Street, New York,N.Y.

Di 3. Doul(laa S.

Lipton,

Ph.D., is Director of Research at Narcotic and Drug Research, Ine., and was formerly Deputy

rector for Research and Evaluation at the New York State Division ofSubstance Abuse Services. This research was

~uPP~rted

byGrant No. ROIDA03281

(MAXIM)

from the National Institute on Drug Abuse to Narcotic and Drug Research,

ne.,

In

COoperation

with the New York State Division ofSubstance Abuse Services. The opinions expressed herein do not

ne:sSaril~

reflect theofficial policiesor positions ofthe sponsoring agencies, norof any individuals exceptthe authors, The

~':'

o~

WIshto thank the staffand patients of the followingmethadone clinics for their participation in this study: Albert

Hlns~1n

Collegeof Medicine MMTP (Trailer II 1), Long Island Jewish-Hillside Medical Center MMTP,and Mount Vernon

~S~'tal

MMTP.

The assistance of the following administrators is especially appreciated: Ira J. Marion and Katherine

(Mr on (Albert Einstein); Kenneth Amann and James Koger(Long Island Jewish); and Theodore Thomas and Paul Ranch

M

~t

Vern.on).

The authors express their deep gratitude for the support and encouragement of this project by Julio A.

Sib nez of Substance Abuse Services); Norwig Debye-Saxinger (First Deputy Director, Division of

S~

s.tance Abuse Services); and Charles LaPorte for Chemotherapy, Division of Substance Abuse

pr~ces):

Salvato~

J. MuM,Morris A. Chedekel, Ronald Melchionda and Kenneth Cochran made useful suggestions in the

istrp~ratl~

of this paper. The Research Committee of the New York State Committee of Methadone Program Admin·

a rs (

OMPA)

provided helpful advice to

MAXIM.

EMIT is a registered trademark of

SYVA

Company.

oJournal ofDrug Issues, Inc. 0022-0426/88/031317-326 $1.00

317