CARE Series - Urine Drug Testing for Substance Use Disorders: Interpretation and Clinical Utility

Jill Warrington, MD, PhD and Tony Folland will:

• Provide a brief evidence review of association between urine testing and SUD treatment outcomes

• Review of urine analysis techniques

  • Point of care

  • Lab immunoassay

  • chromatography/mass spectrometry

• Assessing characteristics of urine sample validity

  • Creatinine

  • Specific gravity

  • pH

  • temperature

• Special topics in testing:

  • Urine drug screen cross reactivity

  • Testing for fentanyl, fentanyl analogues, and novel substances

  • Interpreting buprenorphine/norbuprenorphine ratios

• Guidance for productive discussion of results with patients

• Objectives and frequency of drug testing based on care plan goals

• Drug testing as a treatment intervention and treatment planning tool

Presenters

Jill S. Warrington, MD, PhD
CLIA Director and Technical Consultant
Vermont Department of Health Laboratory
Associate Professor
Dept of Pathology & Laboratory Medicine
UVM Larner College of Medicine

Tony Folland
State Opiate Treatment Authority
Manager of Clinical ServicesVermont Department of Health

1. Rate quality of evidence for association between urine toxicology testing and Substance Use Disorder treatment outcomes.
2. Compare clinical utility of point of care urine toxicology testing with chromatography/mass spectrometry testing for the treatment of Substance Use Disorders.
3. Describe one best practice principle for discussing urine toxicology results with patients in treatment for Substance Use Disorders.

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

American Medical Association (AMA)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 ANCC contact hours. 

All other learners may claim CME-designated participation credit. Consult your professional licensing board regarding the applicability and acceptance of CME-designated participation credit for programs certified for credit by organizations accredited by Joint Accreditation for Interprofessional Education.

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Bibliographic Material

• Dupouy et al. Does urine drug abuse screening help for managing patients? A systematic review, Drug and Alcohol Dependence, Volume 136, 2014,

  Pages 11-20, ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2013.12.009.

• Jarvis M, Williams J, Hurford M, Lindsay D, Lincoln P, Giles L, Luongo P, Safarian T. Appropriate Use of Drug Testing in Clinical Addiction Medicine. J Addict Med. 2017 May/Jun;11(3):163-173. https://doi.org/10.1097/ADM.0000000000000323. PMID: 28557958.

• Kirsh KL, Baxter LE, Rzetelny A, Mazuk M, Passik SD. A Survey of ASAM Members' Knowledge, Attitudes, and Practices in Urine Drug Testing. J Addict Med. 2015 Sep-Oct;9(5):399-404. https://doi.org/10.1097/ADM.0000000000000146. PMID: 26335003.

• Kolla BP, Callizo GL, Schneekloth TD. Utility of Urine Drug Testing in Outpatient Addiction Evaluations. J Addict Med. 2019 May/Jun;13(3):188-192. https://doi.org/10.1097/ADM.0000000000000477. PMID: 30418336.

• Lachenmeier DW, Sproll C, Musshoff F. Poppy seed foods and opiate drug testing--where are we today? Ther Drug Monit. 2010 Feb;32(1):11-8. https://doi.org/10.1097/FTD.0b013e3181c0eee0. PMID: 19901868.

• van Vredendaal, R., Venema, S., Kuipers, S., Boonstra, N., & Spoelstra, S. K. (2026). Lived Experiences of Urine Drug Testing Among Individuals with a Substance Use Disorder: A Punitive or Supportive Intervention? Nursing Reports, 16(2), 38. https://doi.org/10.3390/nursrep16020038

• Vermont Medicaid. Vermont Office-Based Opioid Treatment Stability Index. 2017. https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/iap-downloads/reducing-substance-use-disorders/vt-opioid-stability-index.pdf

• Warrington JS, Warrington GS, Francis-Fath S, Brooklyn J. Urinary Buprenorphine, Norbuprenorphine and Naloxone Concentrations and Ratios: Review and Potential Clinical Implications. J Addict Med. 2020 Dec;14(6):e344-e349. https://doi.org/10.1097/ADM.0000000000000676. PMID: 32530884.

Provider Contact Information
Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
ACE Office
Dartmouth Health
[email protected]

Mitigation of Relevant Financial Relationships

Dartmouth Health adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education.  Any individuals in a position to control the content of a CE activity, including planners, faculty, authors, or others are required to disclose all financial relationships with ineligible companies^.  All relevant financial relationships have been mitigated prior to the commencement of the activity.

^Ineligible Company is any entity whose primary business purpose is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients.