National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA 19104, USA.
J Subst Abuse Treat. 2021 Apr;123:108258. doi: 10.1016/j.jsat.2020.108258. Epub 2020 Dec 20.
The COVID-19 pandemic has led to abrupt changes in the delivery of substance use treatment, notably the adoption of telehealth services and a departure from mandatory urine drug screens (UDS). Amid current circumstances, the UDS, which had evolved to signal a "successful" recovery, no longer seems feasible, safe, or necessary. Even prior to the pandemic, the UDS had notable drawbacks, including sending a message of mistrust and hierarchy, potentially causing psychological trauma, and incentivizing falsification. Nonetheless, certain patients may state that they depend on the UDS for motivation or structure while some providers may rely on it to discover which patients are struggling. While a combination of self-report and UDS is generally regarded as the strongest measure of substance use among patients, our experiences caring for patients without the results of the UDS during the COVID-19 pandemic have forced us to examine the use of other measures to define a successful recovery. Complete abstinence may not be the goal for all patients and those who achieve abstinence may have additional goals worth supporting. While the UDS will likely be incorporated back into our treatment plans, we suggest unseating it as the centerpiece of substance use care and discovering additional methods of measuring our patients' outcomes in less traumatizing and more patient-centered ways.
COVID-19 大流行导致物质使用治疗的提供方式发生了突然变化，特别是采用了远程医疗服务，并放弃了强制性尿液药物检测（UDS）。在当前情况下，曾经用于表示“成功”康复的 UDS 似乎不再可行、安全或必要。即使在大流行之前，UDS 也存在明显的缺陷，包括发出不信任和等级制度的信息，可能会造成心理创伤，并刺激伪造。尽管如此，某些患者可能会表示他们依赖 UDS 来获得动力或结构，而一些提供者可能依赖它来发现哪些患者正在挣扎。虽然自我报告和 UDS 的结合通常被认为是衡量患者物质使用的最强指标，但在 COVID-19 大流行期间，我们在没有 UDS 结果的情况下照顾患者的经验迫使我们检查使用其他措施来定义成功的康复。完全戒除可能不是所有患者的目标，那些戒除的患者可能还有其他值得支持的目标。虽然 UDS 可能会重新纳入我们的治疗计划，但我们建议将其从物质使用护理的中心位置上移开，并以更少创伤和更以患者为中心的方式发现衡量患者治疗效果的其他方法。
