(13) Testing and analysis for drugs.(a) Use.1. A service shall use drug tests and analyses to determine the presence in a patient of opiates, methadone, amphetamines, cocaine or barbiturates. If any other drug has been determined by a service or the state methadone authority to be abused in that service's locality, a specimen shall also be analyzed for that drug. Any laboratory that performs the testing shall comply with 42 CFR Part 493.2. A service shall use the results of a drug test or analysis on a patient as a guide to review and modify treatment approaches and not as the sole criterion to discharge the patient from treatment.3. A service's policies and procedures shall integrate testing and analysis into treatment planning and clinical practice.(b) Drawing blood for testing. A service shall determine a patient's drug levels in plasma or serum at the time the person is admitted to the service to determine a baseline. The determinations shall also be made at 3 months, 6 months and annually subsequently. If a patient requests and receives doses above 100 milligrams, serum levels shall be drawn to evaluate peak and trough determinations after the patient's dose is stabilized.(c) Obtaining urine specimens. A service shall obtain urine specimens for testing from a patient in a clinical atmosphere that respects the patient's confidentiality, as follows:1. A urine specimen shall be collected upon each patient's service visit and specimens shall be tested on a random basis.2. The patient shall be informed about how test specimens are collected and the responsibility of the patient to provide a specimen when asked.3. The bathroom used for collection shall be clean and always supplied with soap and toilet articles.4. Specimens shall be collected in a manner that minimizes the possibility of falsification.5. When service staff must directly observe the collection of a urine sample, this task shall be done with respect for patient privacy.(d) Response to positive test results.1. Service staff shall discuss positive test results with the patient within one week after receipt of results and shall document them in the patient's case record with the patient's response noted.2. The service shall provide counseling, casework, medical review and other interventions when continued use of substances is identified. Punishment is not appropriate.3. When there is a positive test result, service staff shall allow sufficient time before retesting to prevent a second positive test result from the same substance use.4. Service staff confronted with a patient's denial of substance use shall consider the possibility of a false positive test.5. Service staff shall review a patient's dosage and shall counsel the patient when test reports are positive for morphine-like substances and negative for the FDA-approved narcotic treatment.(e) Monitoring of test reports. A service shall monitor test reports to do all of the following:1. Ensure compliance with this section and with federal regulations.2. Discover trends in substance use that may require a redirection of clinical resources.3. Ensure that staff appropriately address with the patient a positive test report within one week after the report is received and that the report and the patient's response is documented in the patient's case record.(f) Frequency of drug screens.1. The frequency that a service shall require drug screening shall be clinically appropriate for each patient and allow for a rapid response to the possibility of relapse.2. A service shall arrange for drug screens with sufficient frequency so that they can be used to assist in making informed decisions about take-home privileges. see full law