Less Intensive Urine Drug Screening in Buprenorphine Treatment

Introduction: Office based opioid treatment (OBOT) programs that provide buprenorphine to patients with opioid use disorder (OUD) typically depend on urine drug screening (UDS), often at every visit. Optimal frequency of UDS for monitoring is unknown. We hypothesize that a less intensive UDS protocol results in fewer tests without differences in unfavorable UDS results. 

Methods: We performed a retrospective review of patients with OUD enrolled in a single OBOT program that implemented a protocol in April 2019 randomizing UDS. All patients provided a urine sample upon arrival to clinical appointments, but UDS was completed only for half of randomly selected samples except during the first 4 weeks of treatment or if there was a discrepancy between self-report and UDS result on the preceding test. Eligible patients were ≥18yrs with at least one UDS result between 4/8/2018 and 2/29/2020. We compared the number of UDS per person each calendar month before versus after the UDS protocol change, as well as the rates of unfavorable UDS results (negative for buprenorphine, positive for opioids or stimulants).

Results: There were 222 eligible patients -- 69% male, aged 19-71, 75% White. There was an average of 1.2 and 0.87 UDS per patient per month before and after the protocol change, respectively, despite no appreciable change in the number of patients enrolled. During the pre- and post- protocol change periods, respectively, 5.8% and 7.2% of UDS were negative for buprenorphine, 19.6% and 23.2% were positive for opioids and 21.4% and 22.5% were positive for stimulants; none of these differences were statistically significant (p>0.05).

Conclusion: A protocol randomizing UDS in an OBOT clinic resulted in fewer UDS per patient per month and similar rates of unfavorable test results. Less intensive UDS protocols may be an acceptable means of monitoring patients with OUD enrolled in OBOT programs.

References:

1. Baxter L, Brown L, Pating D, et al. Appropriate Use of Drug Testing in Clinical Addiction Medicine. Published online 2017:56.

2. Jarvis M, Williams J, Hurford M, et al. Appropriate Use of Drug Testing in Clinical Addiction Medicine: Journal of Addiction Medicine. 2017;11(3):163-173. doi:10.1097/ADM.0000000000000323

3. Barthwell AG. Clinical and Public Health Considerations in Urine Drug Testing to Identify and Treat Substance Use. Substance Use & Misuse. 2016;51(6):700-710. doi:10.3109/10826084.2015.1135953

Learning Objective: Evaluate possible alternatives to routine urine drug screening for OBOT programs.