Evaluation of ongoing oxycodone abuse among methadone-maintained patients

Area of Science:

• Addiction Medicine
• Clinical Chemistry
• Pharmacology

Background:

• Prescription opioid abuse is a growing public health concern in the United States.
• Increased prescription opioid use is observed in patients seeking treatment for opioid dependence.
• Current urinalysis methods may not adequately detect ongoing oxycodone abuse in methadone maintenance patients.

Purpose of the Study:

• To assess the prevalence of undetected oxycodone abuse among patients in a methadone maintenance (MM) treatment program.
• To compare the efficacy of standard enzyme multiplied immunoassay test (EMIT) opiate assays with supplemental oxycodone test strips in detecting oxycodone use.

Main Methods:

• A quality assurance project involving 105 MM patients who provided 437 urine samples over six weeks.
• Urine samples were analyzed using a standard EMIT opiate assay (300 ng/ml cutpoint) and a supplemental oxycodone test strip (100 ng/ml cutpoint).

Main Results:

• The standard EMIT assay identified only 6% of samples as positive for oxycodone.
• The supplemental oxycodone test strip detected recent oxycodone use in 19% of samples.
• Oxycodone users were more likely to have a prescription opioid as their primary drug at intake and shorter treatment duration.

Conclusions:

• Standard urinalysis may underestimate oxycodone use in methadone maintenance patients.
• Supplemental oxycodone testing is crucial for accurate monitoring of patient stability and treatment progress.
• Findings have implications for clinical decisions regarding medication dosage and take-home privileges.