Testimony in Support of Oklahoma HB 3326, Making Observance of Drug Testing Optional in Narcotic Treatment Programs
Testimony from:
Stacey McKenna, Resident Senior Fellow, R Street Institute
In SUPPORT of HB 3326, AN ACT “modifying mandatory observance of drug abuse testing” in narcotic treatment programs.
February 28, 2024
House Committee on Public Health
Chair Roe and Members of the Committee,
Thank you for considering my testimony. My name is Stacey McKenna, and I study opioid harm reduction for the R Street Institute, a nonprofit, nonpartisan public policy research organization. R Street promotes free markets and limited yet effective government via policy research and outreach in a variety of policy areas, including integrated harm reduction. A pragmatic approach to health, harm reduction recognizes that some people will always engage in risky behaviors, and that the government should not prevent them from taking the initiative to stay as safe and as healthy as possible.[1] This is why OK HB 3326 is of special interest to us: The bill will improve the ability of medical professionals to provide effective, individualized care to patients with opioid use disorder.
An estimated 2.7 million to 7.6 million Americans are living with an opioid use disorder (OUD).[2] Roughly 20 percent of Oklahomans need treatment for mental health or substance use disorders.[3] Furthermore, thanks to the increasingly unpredictable and dangerous illicit drug supply, opioid use disorder is more dangerous than ever. In 2023, more than 112,000 Americans died of a drug overdose, the majority of which involved illicitly manufactured fentanyl or other synthetic opioids.[4] While opioids have not affected Oklahoma as much as some other parts of the country, the number of fentanyl-involved deaths in the state increased 12-fold from 2019 to 2022.[5]
Two medications—buprenorphine and methadone—can drastically reduce the suffering associated with opioid use disorder and save people’s lives. These medications for opioid use disorder (MOUD) prevent withdrawal symptoms and cravings, and help people feel physically and emotionally well enough to focus on piecing their lives back together. Compared to individuals on non-medication treatment, patients on MOUD are 2 to 4 times more likely to stay in treatment, and less likely to use illicit substances.[6] Buprenorphine reduces risk of overdose death by 38 percent, while methadone reduces risk of overdose death by 59 to 80 percent compared to people in non-medication treatment programs.[7]
However, access to life-saving MOUD remains insufficient in the United States, with only 13 to 27 percent of people with OUD accessing the treatment in a given year.[8] One factor that can prevent people with an OUD from seeking or continuing treatment is the quality of the care itself, including how one is treated within the therapeutic setting.[9] While testing OUD patients’ urine for illicit and non-prescribed drugs is a common practice, decisions on how often these screenings occur, and how they are conducted, should be made between patient and provider, not mandated by the government.[10]
Furthermore, while many patients believe that urine tests help keep them on track in their recovery program, they also find observed screenings to be humiliating and harmful.[11] These unintended consequences may be amplified for individuals who have suffered traumas such as sexual abuse.[12] This diminished quality of care, especially when carried out regardless of the individual’s adherence or risk of continuing to use illicit drugs in turn discourages some people from initiating or continuing participation in treatment.[13]
OK HB 3326 would address this issue by removing the requirement that treatment programs for opioid use disorder observe patient urination as part of their programs’ drug screening efforts. By simply changing the “shall” to “may,” this bill takes this decision out of the hands of the government and places it in the hands of medical and substance use disorder treatment professionals. Not only does this preserve the idea of the patient-provider relationship, it strengthens patient-provider trust, and bolsters the therapeutic value of individual relationships. Research suggests that these factors are likely to improve patient initiation and retention in OUD treatment.
The government, and thus the state of Oklahoma, should not be making detailed decisions about the best way to deliver treatment for substance use disorder and help patients stay on track with their recovery goals. Rather, medical providers and addiction professionals should be working with their patients to do what sets them up to remain in treatment and have successful outcomes. Therefore, we strongly urge the Legislature to pass HB 3326.
Thank you for your time,
Stacey McKenna
Resident Senior Fellow
Integrated Harm Reduction
R Street Institute
970-443-8063
[email protected]
[1] Mazen Saleh and Chelsea Boyd, “R Street Integrated Harm Reduction Principles and Priorities,” R Street Explainer, Dec. 14, 2021. https://www.rstreet.org/research/r-street-integrated-harm-reduction-principles-and-priorities.
[2] “Opioid Use Disorder,” Centers for Disease Control and Prevention, Aug. 30, 2022. https://www.cdc.gov/dotw/opioid-use-disorder/index.html#:~:text=About 2.7 million people in the United States report suffering from OUD; Noa Krawczyk et al., “Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019,” International Journal of Drug Policy 110 (December 2022). https://www.sciencedirect.com/science/article/pii/S0955395922002031.
[3] “Treatment,” Oklahoma Mental Health & Substance Abuse, 2020. https://oklahoma.gov/odmhsas/treatment.html.
[4] https://www.npr.org/2023/12/28/1220881380/overdose-fentanyl-drugs-addiction#:~:text=In 2023 the overdose death,for Disease Control and Prevention.&text=Biden administration officials say they have “flattened” the upward curve.
[5] “Data,” Drug Overdose, Oklahoma State Department of Health, Accessed Feb. 27, 2024. https://oklahoma.gov/health/health-education/injury-prevention-service/drug-overdose/data.html.
[6] “How effective are medications to treat opioid use disorder?” Medications to Treat Opioid Use Disorder Research Report, National Institute on Drug Abuse, December 2021. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder.
[7] Marc R. Larochelle et al., “Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study,” Annals of Internal Medicine, (June 19, 2018). https://www.acpjournals.org/doi/10.7326/M17-3107; Noa Krawczyk et al., “Opioid agonist treatment and fatal overdose risk in a state-wide US population receiving opioid use disorder services,” Addiction, 115: 9, (Feb. 24, 2020), pp. 1683-1694. https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14991.
[8] “Opioid Use Disorder.” https://www.cdc.gov/dotw/opioid-use-disorder/index.html#:~:text=About 2.7 million people in the United States report suffering from OUD; Krawczyk et al. https://www.sciencedirect.com/science/article/pii/S0955395922002031.
[9] David Frank et al., “It’s Like ‘Liquid Handcuffs’: The Effects of Take-Home Dosing Policies on Methadone Maintenance Treatment (MMT) Patients’ Lives,” Harm Reduction Journal, 18: 88, (2021). https://doi.org/10.1186/s12954-021-00535-y.
[10] Halle G. Sobel et al., “A Descriptive analysis of urine drug screen results in patients with opioid use disorder managed in a primary care setting,” Addiction Science & Clinical Practice, 16: 59, (2021). https://doi.org/10.1186/s13722-021-00264-4.
[11] Bodil Monwell, et al., “The pros and cons of supervised urine tests in opioid replacement therapy: A study of patients’ experiences,” Heroin Addiction & Related Clinical Problems,” (2018). https://www.diva-portal.org/smash/get/diva2:1400883/FULLTEXT01.pdf; C. Strike and C. Rufo, “Embarrassing, Degrading, or Beneficial: Patient and Staff Perspectives on Urine Drug Testing in Methadone Maintenance Treatment,” Journal of Substance Use, 15: 5 (2010), pp. 303-312. https://doi.org/10.3109/14659890903431603.
[12] Monwell et al. https://www.diva-portal.org/smash/get/diva2:1400883/FULLTEXT01.pdf.
[13] Frank et al. https://doi.org/10.1186/s12954-021-00535-y.