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Acceptability and accuracy of oral fluid drug testing for patients on methadone maintenance

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript



Methadone maintenance is currently the predominant form of opioid substitution treatment available in the Republic of Ireland. Prescribing decisions currently involve urine testing for drug use. Urine testing may involve provision of a supervised sample in some circumstances, despite recommendations made in 2010 to abandon this practice.


This project aims to evaluate the accuracy and acceptability of oral fluid testing for patients on methadone maintenance and also gather patient views on their treatment.


Patients attending for methadone maintenance at 4 general practices were invited to take part in this study, which involved taking an additional oral fluid test and a questionnaire.


Fifty-five patients agreed to participate. Fifty-two (95%) found the oral fluid test acceptable, and almost two-thirds would prefer to see it used instead of urine testing. Oral fluid provided similar results to urine testing for all drugs except benzodiazepines. Self-report identified cocaine and opiate use not detected by oral fluid or urine testing.


This study presents evidence that oral fluid testing is acceptable to most patients. While oral fluid testing was inferior to urine testing for benzodiazepines, it may have an adjunctive role to play in methadone maintenance provision. Patients reported more negative than positive aspects of methadone maintenance.

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Republic of Ireland


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The authors wish to thank the general practitioners and the patients who agreed to participate in this study.


This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors. Oral fluid testing kits were purchased by the lead author from Alere toxicology (total cost €800) following unsuccessful attempts to procure research funding. Neither the lead author or any of the authors are in any way associated with this private company nor any other provider of drug testing equipment.

As urine testing is the standard of care in Ireland, all 4 participating general practices had free access to urinary testing.

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Correspondence to Michael Edmund O’Callaghan.

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The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval for the study was obtained from the Trinity College Dublin/Health Service Executive (TCD/HSE) GP Training Scheme Ethics Committee.


Point-of-care testing:Testing for drug metabolites at the point-of-care (i.e., result available immediately such that it can impact on current consultation)

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• First study of views of patients on methadone maintenance in Ireland

• Oral fluid testing acceptable to 95% of patients

• Oral fluid testing non-inferior to urine testing for all drugs except benzodiazepines

• General practitioners in favor of oral fluid testing in that it provides an additional method of evaluating patient stability

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The material presented herein has not been published in any other journal.

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O’Callaghan, M.E., Regan, L., Wilson, M. et al. Acceptability and accuracy of oral fluid drug testing for patients on methadone maintenance. Ir J Med Sci 189, 557–561 (2020).

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