As opioid-related mortality has increased in the United States, greater emphasis has been placed on ensuring access to medications for opioid use disorder(MOUD) and improving outcomes. While abstinence using urine toxicology testing was a mainstay of assessing MOUD treatment outcomes, there have been major shifts in clinical, research, and public health communities away from placing untoward emphasis on these metrics. Herein we challenge the purported objective truth of urine testing and highlight how we can be easily fooled into thinking a patient is or is not abstinent. We highlight the potential value of patient-reported outcomes (PROMs) that are easily obtained and may more accurately reflect the benefits of MOUD, such as decreases in overdose, retention in treatment, and improved health outcomes.