Abstract
BackgroundUrine drug screening (UDS) is commonly used as part of treatment for opioid use disorder (OUD), including treatment with buprenorphine-naloxone for OUD in a primary care setting. Very little is known about the value of UDS, the optimum screening frequency in general, or its specific use for buprenorphine treatment in primary care. To address this question, we thought that in a stable population receiving buprenorphine-naloxone in the primary care setting it would be useful to know how often UDS yielded expected and unexpected results.MethodsWe present a descriptive analysis of UDS results in patients treated with buprenorphine-naloxone for OUD in a primary care setting over a two-year period. An unexpected test result is:A negative test for buprenorphine and/orA positive test for opioids, methadone, cocaine and/or heroin.ResultsA total of 161 patients received care during the study period and a total of 2588 test results were analyzed from this population.We found that 64.4% of the patient population (n = 104 patients) demonstrated both treatment adherence (as measured by buprenorphine positive test results) and no apparent unexpected test findings, as defined by negative tests for opioids, methadone, cocaine and heroin. Of the 161 patients, 20 results were positive for opioids, 5 for methadone, 39 for heroin and 2 for cocaine.Analysis at the UDS level demonstrated that, of the 2588 test results, 38 (1.5%) results did not have buprenorphine. Of the 2588, 28 (1.1%) test results were positive for opioids, 8 (0.3%) were positive for methadone, 39 (1.5%) for cocaine and 2 (0.1%) for heroin.ConclusionGiven that the majority of patients in our study had expected urine results, it may be reasonable for less frequent urine testing in certain patients.
Highlights
The Substance Abuse and Mental Health Services Administration federal guidelines for opioid treatment programs mandate that programs administer adequate testing for drugs of abuse, including at least eight randomSobel et al Addict Sci Clin Pract (2021) 16:59 drug tests yearly per patient in maintenance treatment [15]
A systematic literature review on the effect of and recommendations for the frequency of Urine drug screening (UDS) on health outcomes for persons with opioid use disorder (OUD) who receive opioid agonist therapy found only one study meeting their inclusion criteria. They noted an overall lack of evidence for the association between frequent urine drug screening and health outcomes and an “urgent gap in research evidence underpinning an area of clinical importance.” [10]
Consensus guidelines developed by the American Society of Addiction Medicine Board of Directors recommended that UDS should be done weekly in early recovery and could be decreased to monthly in stable recovery but cited in their 2017 Consensus Statement on Appropriate Use of Drug Testing in Clinical Addiction Medicine that more research in this subject would be useful [1]
Summary
The Substance Abuse and Mental Health Services Administration federal guidelines for opioid treatment programs mandate that programs administer adequate testing for drugs of abuse, including at least eight randomSobel et al Addict Sci Clin Pract (2021) 16:59 drug tests yearly per patient in maintenance treatment [15]. The American Society of Addiction Medicine in their recent update recommends urine drug screening (UDS) during treatment to monitor patients for adherence to prescribed medications and use of alcohol, illicit, and controlled substances They do not give specific guidance on the frequency of testing except to note that the frequency should be determined by several factors including stability of the patient, type of treatment, and treatment setting. A systematic literature review on the effect of and recommendations for the frequency of UDS on health outcomes for persons with opioid use disorder (OUD) who receive opioid agonist therapy found only one study meeting their inclusion criteria They noted an overall lack of evidence for the association between frequent urine drug screening and health outcomes and an “urgent gap in research evidence underpinning an area of clinical importance.” [10]. A positive test for opioids, methadone, cocaine and/or heroin
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