Polysubstance Use Among Patients Treated With Buprenorphine From a National Urine Drug Test Database

Area of Science:

• Addiction Medicine
• Clinical Pharmacology
• Public Health Surveillance

Background:

• Polysubstance use is a significant concern for patients undergoing treatment for opioid use disorder (OUD).
• While buprenorphine is effective in reducing illicit opioid use, co-occurring use of nonprescribed substances can negatively impact treatment outcomes.
• Characterizing these patterns is essential for optimizing patient care and public health strategies.

Purpose of the Study:

• To identify factors associated with urine drug test (UDT) positivity for nonprescribed substances in patients receiving buprenorphine treatment.
• To understand the prevalence and trends of polysubstance use among individuals with OUD on buprenorphine therapy.

Main Methods:

• A cross-sectional study analyzed 150,000 initial UDT specimens from patients prescribed buprenorphine between 2013 and 2019.
• Specimens were tested for buprenorphine and various nonprescribed substances using liquid chromatography-tandem mass spectrometry.
• Multivariable logistic regression examined associations between substance positivity and patient demographics, care setting, payer, and collection year.

Main Results:

• Over 47% of patients tested positive for at least one nonprescribed substance, with increasing positivity rates for substances like fentanyl from 2013-2019.
• Factors associated with positivity varied significantly by substance; for example, fentanyl positivity was higher in younger men with Medicaid, while oxycodone positivity was higher in older women with private insurance.
• Patients positive for buprenorphine were less likely to test positive for other opioids like fentanyl and heroin.

Conclusions:

• Patterns of nonprescribed substance positivity among patients on buprenorphine for OUD are diverse and influenced by various factors.
• UDT is a valuable tool for public health surveillance of polysubstance use in this population.
• Findings underscore the need for tailored monitoring and intervention strategies based on individual patient profiles and substance use patterns.