key: cord-1038760-hba9gat0
authors: Saloner, Brendan; Whitley, Penn; LaRue, Leah; Dawson, Eric; Huskey, Angela
title: Polysubstance Use Among Patients Treated With Buprenorphine From a National Urine Drug Test Database
date: 2021-09-10
journal: JAMA Netw Open
DOI: 10.1001/jamanetworkopen.2021.23019
sha: 65edbb4caff83697d60998d4d9a8268e3074ac2a
doc_id: 1038760
cord_uid: hba9gat0

IMPORTANCE: Polysubstance use is a concern for patients treated for opioid use disorder (OUD). While buprenorphine can curtail harmful opioid use, co-occurring use of nonprescribed substances, such as cocaine, methamphetamine, and other opioids, may negatively affect treatment outcomes. OBJECTIVE: To characterize factors associated with urine drug positivity for nonprescribed substances among patients prescribed buprenorphine. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included patients who had been prescribed buprenorphine and who provided urine specimens for urine drug testing (UDT), as ordered by clinicians in primary care or behavioral health or at substance use disorder treatment centers, from 2013 to 2019. Specimens were analyzed by liquid chromatography–tandem mass spectrometry to assess positivity for several commonly used substances. EXPOSURES: Buprenorphine prescription. MAIN OUTCOMES AND MEASURES: Positivity for buprenorphine and several nonprescribed substances. Unadjusted trends in positivity for each nonprescribed substance were compared between specimens that did and did not test positive for buprenorphine. Multivariable logistic regression was used to examine factors associated with positivity; factors included patient age, sex, setting of care, payer, collection year, and census division. RESULTS: The study included first UDT specimens from 150 000 patients, of whom 82 107 (54.74%) were men and 77 300 (51.53%) were aged 18 to 34 years. Across all specimens, 128 240 (85.49%) were positive for buprenorphine, and 71 373 (47.58%) were positive for 1 or more nonprescribed substances. From 2013 to 2019, positivity rates increased for most substances (eg, fentanyl: from 131 of 21 412 [0.61%] to 1464 of 13 597 [10.77%]). Factors associated with positivity varied widely by substance; for example, fentanyl positivity was highest for men (OR, 1.13; 95% CI, 1.06-1.21), patients aged 18 to 24 years (OR for patients ≥55 years, 0.46; 95% CI, 0.39-0.54), patients living in New England (OR, 1.19; 95% CI, 1.07-1.33), and patients with Medicaid (OR, 1.20; 95% CI, 1.11-1.31), whereas oxycodone positivity was greatest for women (OR for men, 0.84; 95% CI, 0.79-0.89), patients older than 55 years (OR, 1.42; 95% CI, 1.22-1.64), patients living in the South Atlantic (OR, 1.45, 95% CI, 1.33-1.58), and patients with private insurance (OR for Medicaid, 0.78; 95% CI, 0.73-0.84). Patients whose specimens were positive for buprenorphine were significantly less likely to be positive for other opioids (eg, fentanyl: OR for buprenorphine-negative samples, 6.71; 95% CI, 6.29-7.16; heroin: OR for buprenorphine-negative samples, 9.93; 95% CI, 9.31-10.59). CONCLUSIONS AND RELEVANCE: In this cross-sectional study, patterns of nonprescribed substance positivity among patients prescribed buprenorphine varied widely. This study highlights the utility of UDT in public health surveillance efforts related to patients treated with buprenorphine for OUD.

Note: Non-prescribed and/or illicit positivity rates (%) for alcohol, benzodiazepines, cocaine, fentanyl, gabapentin, heroin, hydrocodone, marijuana, methadone, methamphetamine, oxycodone, and tramadol stratified by detection of prescribed buprenorphine. Percent positivity rates and 95% CI values are calculated by year. Total positivity was calculated without buprenorphine stratification.

Comparison of Characteristics for UDT Specimens From the First and Second Specimen Sample Populations Collected Between

Characteristic 1st Specimen 2nd Specimen Unique Patient Specimens

48%) Health Care Practice Specialty Substance Use Treatment 82,296 (54.86%) 80,496 (58.45%) Behavioral Health 22,575 (15.05%) 19,042 (13.83%) Primary Care Physician 45,129 (30.09%) 38,184 (27.73%) Payor Group Private insurance

Notes: Adjusted marginal probabilities and adjusted Odds Ratios for the 1 st and 2 nd specimen sample populations are shown a Gabapentin aOR was not found to be significant in either the 1 st or 2 nd sample populations. All other aOR values were significant for both sample populations at the p<=0.05 level.