If a patient presents as extremely resistant, a counselor can still continue to offer support along with case management and referral services. These case management issues may include any number of topics. Since 1972, urine screening has been a required procedure in methadone maintenance treatment. Currently, in the OMT level of care, new patients are required to submit nine urinalysis screens, per year, to meet FDA and NIDA guidelines. After the first year of treatment, the urine screen requirement drops to four urines per year.
Some controversy exists around the procedures and use of urine collections and tests.
Depending on individual clinics, urines may be observed, while other clinics do not observe. Some clinics may use urine test results in a punitive way, taking away take-home privileges or even discharging patients with continued drug use.