“Understanding what was recently used or taken, which is frequently either unknown to those in treatment or not disclosed, allows me to make better treatment decisions.”

Medication Nonadherence with Prescribed Treatment in Individuals with Co-occurring Substance Use Disorder and Mental Illness

Medication adherence is of significant importance when assessing an individual’s progress towards meeting treatment goals. This is true regardless of the condition that is being treated, and can be especially important in managing individuals with a combination of mental health conditions and opioid use disorder. Dr. Jane Weinberg, a psychiatrist practicing in Nashville, TN, manages individuals with complex conditions and needs. “Definitive testing of urine and oral fluid specimens provides me with an opportunity to not only assess medication adherence and non-prescription substance use, but also helps to close care gaps by identifying other substances that are used that are prescribed by providers outside of my practice that are not disclosed during assessment. The information provided by definitive testing is key to my clinical decision-making and is also invaluable in educating those I treat.”

The results below were reported based on testing of a specimen submitted by a female patient in her thirties in treatment for opioid use disorder. This individual was prescribed buprenorphine at the time of testing, which was not found to be present, and several non-prescription substances were detected.

“Definitive testing, in this instance, provided a great deal of valuable information. Not only was I able to identify that the prescription buprenorphine that I was using to treat the individual was not found, but I also was able to identify multiple non-prescription substances that create a significant risk for an adverse event, including the designer benzodiazepine bromazolam. This sort of testing is of great importance not only in individuals that are using very high-risk drug combinations, but also in those that are stating lack of therapeutic efficacy of prescribed medications. Understanding what was recently used or taken, which is frequently either unknown to those in treatment or not disclosed, allows me to make better treatment decisions,” said Weinberg.

With regards to breadth of available testing, and what is used within her population, Dr. Weinberg provided some interesting insights. “Substances that are used that can impact treatment are wide-ranging, are often times not identifiable through controlled substance database reports, and many times are unable to be tested via presumptive methods. Within my practice, I frequently see substances not prescribed to my patient such as gabapentin, tramadol, or designer benzodiazepines and infrequently kratom. It is important to leverage testing in a manner that supports my clinical decisions as well as furthers my ability to educate individuals in treatment.”

Dr. Jane Weinberg, Psychiatrist
Dr. Weinberg is a psychiatrist in Nashville, Tennessee with expertise in treating depression, bipolar disorder, anxiety disorders, among other conditions.