The pitfalls of urine surveillance: the role of research in evaluation and remedy.

Millions of dollars and a great deal of staff time in methadone programs are spent on urine screening, but the difficulties inherent in such testing are rarely documented. An evaluation of the accuracy of the urine screening procedure used for a methadone maintenance clinic revealed the unusually high danger of inaccuracy in laboratory results. Feedback of this information to the laboratory resulted in significant decrease in the frequency of erroneous reports. Two subsequent evaluations were carried out, each leading to improved precision and accuracy in the reports received subsequently. The importance of this improvement in the level of accuracy of the reports to the operation of the clinic are discussed.