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Polydrug use among patients on methadone medication treatment: Evidence from urine drug testing to inform patient safety.

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Title: Polydrug use among patients on methadone medication treatment: Evidence from urine drug testing to inform patient safety.
Authors: Saloner, Brendan, Whitley, Penn, Dawson, Eric, Passik, Steven, Gordon, Adam J., Stein, Bradley D.
Source: Addiction. Aug2023, Vol. 118 Issue 8, p1549-1556. 8p. 3 Charts, 1 Graph.
Subjects: Methadone treatment programs, Substance abuse, Confidence intervals, Liquid chromatography, Retrospective studies, Acquisition of data, Fentanyl, Drug use testing, Methamphetamine, Treatment effectiveness, Medical records, Mass spectrometry, Cocaine, Descriptive statistics, Research funding, Urinalysis, Odds ratio, Patient safety
Abstract: Aims: Patients in methadone medication treatment for opioid use disorder (M‐MOUD) typically have a complex history of opioid use, often in combination with other drugs. It is unknown how frequently M‐MOUD patients experience persistent substance or polysubstance use. We measured trends in illicit substance use in a large, multistate population of M‐MOUD patients and persistence of substance use in the first year of treatment. Design: Retrospective cohort study of United States (US) M‐MOUD patients from 2017 to 2021, focused on urine drug specimens provided for testing to Millennium Health, a third‐party laboratory. Specimens were analyzed using liquid chromatography–tandem mass spectrometry (LC‐MS/MS). Generalized estimating equations (GEE) were used to estimate the average trends in positivity during time in treatment. Setting: Specimens were obtained from clinics in 10 US states that provided at least 300 unique patients during the study period (Alaska, Arizona, Florida, Illinois, Kentucky, Minnesota, New Mexico, Ohio, Virginia and Washington). Participants: Patients with opioid use disorder receiving M‐MOUD (n = 16 386). Measurements Positivity rates for heroin, fentanyl, methamphetamine and cocaine. Findings From 2017 to 2021, yearly crude positivity rates for first collected specimens increased for fentanyl (13.1%–53.0%, P < 0.001), methamphetamine (10.6%–27.2%, P < 0.001) and cocaine (13.8%–19.5%, P < 0.001); for heroin positivity did not significantly change (6.9%–6.5%, P = 0.74). In regression models estimating patient trajectories from week 1 to week 52, marginal fentanyl positivity declined from 21.8% to 17.1% (incidence rate ratio [IRR] = 0.78, P < 0.001) and heroin positivity declined from 8.4% to 4.3% (IRR = 0.51, P < 0.001), but positivity for methamphetamine and cocaine did not significantly change, remaining at an average of 17.7% (IRR = 0.98, P = 0.53) and 9.2% (IRR = 0.96, P = 0.36), respectively. Conclusions: Between 2017 and 2021, United States patients presenting to opioid treatment programs increasingly tested positive for fentanyl, methamphetamine and cocaine. Methadone medication treatment for opioid use disorder appears to remain an effective intervention for reducing illicit opioid use. [ABSTRACT FROM AUTHOR]
Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Polydrug use among patients on methadone medication treatment: Evidence from urine drug testing to inform patient safety.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Addiction%22&quot;&gt;Addiction&lt;/searchLink&gt;. Aug2023, Vol. 118 Issue 8, p1549-1556. 8p. 3 Charts, 1 Graph.
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  Data: Aims: Patients in methadone medication treatment for opioid use disorder (M‐MOUD) typically have a complex history of opioid use, often in combination with other drugs. It is unknown how frequently M‐MOUD patients experience persistent substance or polysubstance use. We measured trends in illicit substance use in a large, multistate population of M‐MOUD patients and persistence of substance use in the first year of treatment. Design: Retrospective cohort study of United States (US) M‐MOUD patients from 2017 to 2021, focused on urine drug specimens provided for testing to Millennium Health, a third‐party laboratory. Specimens were analyzed using liquid chromatography–tandem mass spectrometry (LC‐MS/MS). Generalized estimating equations (GEE) were used to estimate the average trends in positivity during time in treatment. Setting: Specimens were obtained from clinics in 10 US states that provided at least 300 unique patients during the study period (Alaska, Arizona, Florida, Illinois, Kentucky, Minnesota, New Mexico, Ohio, Virginia and Washington). Participants: Patients with opioid use disorder receiving M‐MOUD (n = 16 386). Measurements Positivity rates for heroin, fentanyl, methamphetamine and cocaine. Findings From 2017 to 2021, yearly crude positivity rates for first collected specimens increased for fentanyl (13.1%–53.0%, P &lt; 0.001), methamphetamine (10.6%–27.2%, P &lt; 0.001) and cocaine (13.8%–19.5%, P &lt; 0.001); for heroin positivity did not significantly change (6.9%–6.5%, P = 0.74). In regression models estimating patient trajectories from week 1 to week 52, marginal fentanyl positivity declined from 21.8% to 17.1% (incidence rate ratio [IRR] = 0.78, P &lt; 0.001) and heroin positivity declined from 8.4% to 4.3% (IRR = 0.51, P &lt; 0.001), but positivity for methamphetamine and cocaine did not significantly change, remaining at an average of 17.7% (IRR = 0.98, P = 0.53) and 9.2% (IRR = 0.96, P = 0.36), respectively. Conclusions: Between 2017 and 2021, United States patients presenting to opioid treatment programs increasingly tested positive for fentanyl, methamphetamine and cocaine. Methadone medication treatment for opioid use disorder appears to remain an effective intervention for reducing illicit opioid use. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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    Identifiers:
      – Type: doi
        Value: 10.1111/add.16180
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 8
        StartPage: 1549
    Subjects:
      – SubjectFull: Methadone treatment programs
        Type: general
      – SubjectFull: Substance abuse
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Liquid chromatography
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Acquisition of data
        Type: general
      – SubjectFull: Fentanyl
        Type: general
      – SubjectFull: Drug use testing
        Type: general
      – SubjectFull: Methamphetamine
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      – SubjectFull: Treatment effectiveness
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      – SubjectFull: Medical records
        Type: general
      – SubjectFull: Mass spectrometry
        Type: general
      – SubjectFull: Cocaine
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Research funding
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      – SubjectFull: Urinalysis
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      – SubjectFull: Odds ratio
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      – SubjectFull: Patient safety
        Type: general
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      – TitleFull: Polydrug use among patients on methadone medication treatment: Evidence from urine drug testing to inform patient safety.
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              Text: Aug2023
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              Y: 2023
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