January 20th, 2016

Medication Adherence and Urine Testing

We all know about using urine tests for drugs, but most of the news coverage involves catching people taking illegal, recreational drugs and then not hiring them or firing them or otherwise punishing them.

More recently, urine testing has become standard practice in detox programs for a variety of substances, but especially opioids. When programs started doing this, they _knew_ they were going to find some stuff, but they were somewhat startled by how much they found. Then, once the testing pattern was announced to all new intakes, the amount of unreported stuff showing up in the tests dropped. Precipitously. People comply when they know they can get caught. Basic stuff, but it turns out to be important.

Last May, this press release completely failed to catch my attention:


The idea is to use urine testing -- rather than more expensive and invasive blood testing -- to check for medication compliance for mental illness. Neat idea! If nothing else, the information can lead to productive dialogue between customer and clinician. I found out about this when I was looking at the disclosure statement on this study report:


Ingenuity Health's employees, in the interests of drumming up business and demonstrating that, hey, we do actually have a useful service here, studied medication compliance in ADHD customers.

"About a third of some 4,000 patients who gave urine samples turned up negative for their prescribed stimulants"

Not really what we were hoping to see, of course, but again! Provides the basis for a useful dialogue and _certainly_ can help explain otherwise mysterious stuff.

"In samples where the prescribed stimulant wasn't detected, THC was present more than 20% of the time, and some combination of a nonprescribed opioid, nonprescribed benzodiazepine, THC and/or cocaine was found more than 38% of the time, they reported."

And again, NOT what we were hoping to see, definitely not a complete surprise and, once again, provides the basis for better understanding and dialogue between customer and clinician.

I think individuals can honestly vary in their understanding and beliefs regarding when and even whether ADHD treatment should include medication. But I think it is safe to say that very few people opposed to treating ADHD with medication had in mind replacing it with self-treatment on the scale described above, nor with the substances listed.

I have no idea whether the cost/benefits or signing up for a service such as Ingenuity Health makes sense as a standard of practice for ADHD patients. But I have to wonder. Even if it doesn't make sense from a _medical_ perspective, it might make sense from a lifetime perspective, if catching this stuff early and folding the results into a therapeutic plan helps keep people out of The Pokey.