ABSTRACT

There is a high frequency of urine drug screens performed within forensic patient populations, at significant use of resources and without firm evidence of utility in identifying prohibited substance use, assisting in risk management, or reducing other adversities. This study describes the clinical practice of urine drug testing in a large forensic psychiatric service in Ontario, Canada, and aims to determine the period prevalence of substance use in this setting. Over a three-month period, there were 1493 tests performed in 132 patients, representing 50.4% of patients surveyed and 31.1% of all active patients. Ten percent of urine samples retuned positive for a prohibited substance (most commonly cannabis or alcohol) while a similar proportion were dilute. Although inpatients received double the number of tests as compared to outpatients, they were less likely to return positive. Patients with positive test results were more likely to receive frequent testing, suggesting that clinical teams often employ urine drug screening to monitor those at highest risk for ongoing use, rather than as a method of deterrence or therapeutic intervention. Implications for the continued use of urine drug screening in this patient population, as well as recommendations to better tailor their use, are discussed.

摘要

在法医患者群体中进行尿液药物筛查的频率很高，资源使用量很大，并且没有确凿的证据表明在识别禁用物质使用、协助风险管理或减少其他逆境方面的效用。本研究描述了加拿大安大略省一家大型法医精神病服务机构中尿液药物检测的临床实践，旨在确定这种情况下物质使用的时期流行率。在三个月的时间里，对 132 名患者进行了 1493 次测试，占接受调查的患者的 50.4% 和所有活跃患者的 31.1%。10% 的尿液样本对禁用物质（最常见的是大麻或酒精）呈阳性反应，而类似比例的尿液样本被稀释。尽管住院患者接受的检测数量是门诊患者的两倍，他们不太可能返回阳性。检测结果呈阳性的患者更有可能接受频繁检测，这表明临床团队经常采用尿液药物筛查来监测那些持续使用的风险最高的人，而不是作为一种威慑或治疗干预的方法。讨论了在该患者群体中继续使用尿液药物筛查的意义，以及更好地调整其使用的建议。