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ASAM Calls for “Smarter” Drug Testing Strategies in Addiction Medicine


Earlier this year, the American Society of Addiction Medicine (ASAM) released recommendations for the use of drug testing in the field of addiction medicine. Their best practice guidelines suggest training and resources for addiction medicine teams for conducting practical, evidence-based drug testing.

This article explores the recommendations of the ASAM and how they are evolving into a “smarter” testing model that might help addiction medicine specialists over time.

ASAM Addiction Medicine Recommendations

The ASAM recommendations are called “The ASAM Appropriate Use of Drug Testing in Clinical Addiction Medicine.” Drug testing typically requires the collection of a biological specimen for testing. The problem has been that there has been no universal clinical standard that governs “identification, diagnosis, treatment, medication monitoring, or recovery.”

The recommendations are intended to establish best practice clinical guidelines for clinical teams in these areas. The documents were created to provide a daily program of support to clinical providers in how to select and design testing protocols as well as how to respond to testing results. The guidelines suggest that drug testing should be conducted weekly at the start of treatment and then monthly for those in the recovery phase.

ASAM defines these best practices as “smarter drug testing,” which includes:

  • Increasing random drug tests instead of scheduled procedures.
  • Additional testing beyond urine, but saliva, hair, blood, sweat, or other matrices depending upon the assessment process.
  • Testing that incorporates screening for a broader panel of drugs, beyond the typical five-drug panel normally required.
  • Improving the science behind sample collection and noting the limitations of current technologies.
  • Considering the cost versus gains benefits ratio when testing.

Interestingly, ASAM defines the need for smart testing in the following way:

“The most important challenge in drug testing today is not the identification of every drug we are technologically capable of detecting, but to do medically necessary and accurate testing for those drugs that are most likely to impact clinical outcomes.”

Impact on Addiction Medicine

Drug testing is used, first, as a diagnostic tool upon intake, and then throughout the treatment process, when appropriate. Like any tool, there should be a right way to use it most effectively. The ASAM takes a blunt tool and hones it by establishing intelligent best practices in the use of addiction medicine. By establishing consistent guidelines for drug testing, ASAM will help researchers struggling with inconsistencies in the way these tests are given.

Addiction medicine

These guidelines will help eliminate inconsistencies in drug testing protocols.

These clinical guidelines will also help practitioners understand the proper methodology for conducting drug tests. It will help patients receive more consistent and effective treatment throughout their journey with addiction medicine.

Providing addiction medicine specialists with a set of guidelines rooted in evidence-based medicine will also allow treatment facilities to accurately track and report on efficacy treatment rates and, conversely, rates of drug recidivism. These guidelines will help providers produce better reporting for compliance and funding agencies.

Finally, and certainly most importantly, the ASAM guidelines and recommendations will help the patients themselves in different settings at different stages of treatment. The Journal of Addiction Medicine suggests these recommendations will help clinical providers, “where drug testing is used to assess patients for a substance use disorder, monitor the effectiveness of a treatment plan, and support recovery.”

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