Do No Harm? Rethinking Urine Drug Screens in Treatment of Opioid Use Disorder.

Abstract

Urine drug monitoring is widely used in outpatient addiction treatment, particularly for patients receiving medications for opioid use disorder (MOUD). While intended to support recovery and enhance clinical decision-making, the actual benefits of urine drug screening (UDS) remain uncertain. Evidence demonstrating improved patient outcomes is lacking, and the potential harms of routine screening are often underrecognized. These harms include false positives, patient stigma, racial bias, and trauma. UDS may also strain therapeutic relationships, particularly when used without transparency or patient consent. This essay calls for a more thoughtful, evidence-informed approach to drug screening in primary care. Clinicians should weigh the limitations of UDS and prioritize strategies that build trust, respect patient autonomy, and support long-term recovery.