A Descriptive analysis of urine drug screen results in patients with opioid use disorder managed in a primary care setting

Abstract

Background Urine 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. Methods We 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/or A positive test for opioids, methadone, cocaine and/or heroin. Results A 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. Conclusion Given that the majority of patients in our study had expected urine results, it may be reasonable for less frequent urine testing in certain patients.

Examining the Primary Care Experience of Patients With Opioid Use Disorder: A Qualitative Study

“…Despite all patients actively engaging with medication-based OUD treatment, approximately 40% of participants reported using illicit drugs within the previous 3 months. This is consistent with other studies of primary care–based OUD treatment 33 . Only 36% of the study participants engaged in behavioral health supports.…”

“…This is consistent with other studies of primary care-based OUD treatment. 33 Only 36% of the study participants engaged in behavioral health supports. This may be due to a combination of insurance coverage deficits, limited access to appointments, and transportation barriers.…”

Urine Drug Screening in a Telehealth Setting for the Treatment of Opioid Use Disorder

“…It is thus important for TBOT platforms to consider the complex interplay between clinical suitability for remote care and socioeconomic and digital barriers, aiming to address the latter while not compromising on the former. However, the low rates of unexpected results and declining drug use observed over the first 6 months of care offer further evidence that buprenorphine delivered in TBOT settings is an effective treatment for OUD and suggest that patient-centered drug testing is effective, consistent with prior studies in other settings …”

“…However, the low rates of unexpected results and declining drug use observed over the first 6 months of care offer further evidence that buprenorphine delivered in TBOT settings is an effective treatment for OUD and suggest that patient-centered drug testing is effective, consistent with prior studies in other settings. 42 …”