This is how to do it…

Practitioner preparation work

Collecting samples for drug testing is potentially intrusive and risks confrontation, so, be prepared...

① Have a clear understanding of why testing is being done

② Be aware of the consequences of positive tests for the individual

③ Understand the time windows in which detection of particular drugs is likely

④ Understand how to interpret test results

⑤ Know how to detect samples that are invalid.

Helping people to change requires us to start from the service user’s perspective and many will see drug testing as intrusive, punitive or stigmatising. So, drug testing needs to be communicated as a shared interest with positives for the service user. Practitioners need to have the knowledge to interpret test results correctly. Most drugs are eliminated in urine and so this is usually a reliable means of detection. Drugs can also be found in blood, breath, faeces, sweat, saliva, - any body fluid.

Key practitioner skills

It is down to the practitioner to make testing into a positive event...

① Discuss with the service user their understanding of why testing is being done

② Check the service user’s knowledge of time windows for detection of different drugs.

③ Discuss the various consequences of the results

④ Check whether goals need to be reviewed

⑤ Practise what you will say if samples are deemed tampered with in some way

Possible dialogue…

Drug testing, including for alcohol, may be needed in situations such as initial assessments, in preparation for detoxification or to monitor substitute prescribing. The principles are essentially the same. Your interaction depends on whether your role is just doing the test, interpreting it, or both, but always use a motivational style of talking. Your initial conversation may be something like this…

Practitioner: Tell me what you understand to be the purpose of this test?

Service user: You want to know whether I’m using on top?

Practitioner: And what shall we do if you are?

…then after the test is done…

Practitioner: This is what the test shows: methadone, cannabis and cocaine.

Service user: But I haven’t used cocaine for ages and everybody smokes cannabis.

The essential point here is not to get into an argument but be matter-of-fact about what the test shows and say you will make a note of the service user’s comments. If you are the prescriber or key-worker you may need to take some action:

Prescriber/key-worker: There are one or two things of concern. You have missed some appointments and there have been other positive tests, so, let’s talk over how you are and where you want to get to. Let’s look again at what we are aiming to achieve with the methadone, and how best we can achieve this.

Service user: Okay.

Ultimately it may be that a prescription has to be discontinued or changed or that child protection or other risks must be acted upon. The aim is to elicit from the service user what is going on and review goals and prescribing. The service user should feel listened to, should participate in decision making and understand the reasons for any actions that need to be taken.

Practitioner: You have said that you have not used cocaine for weeks; from the test result we know that there has been cocaine in your system recently so either you have taken it without knowing, which you might be worried about, or you find it difficult to talk to me about it, in which case, let’s look at why taking cocaine might be getting in the way of what you want to achieve.