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Drug Alcohol Depend. 2018 Nov 1;192:245-249. doi: 10.1016/j.drugalcdep.2018.08.010. Epub 2018 Sep 25.

Opioid and cocaine use among primary care patients on buprenorphine-Self-report and urine drug tests.

Author information

1
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States; Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States. Electronic address: Sarah.bagley@bmc.org.
2
Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States.
3
Biostatistics and Epidemiology Analytics Center, Boston University School of Public Health, Boston, MA, United States.
4
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States.
5
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States; Boston University School of Public Health, Boston, MA, United States.

Abstract

BACKGROUND:

Urine drug tests (UDTs) are recommended to monitor patients treated for opioid use disorder in primary care. The aims are to (1) estimate the frequency of self-report and UDT results of opioid and cocaine use and (2) evaluate the association between treatment time with non-disclosure of opioid or cocaine use and having a positive UDT.

METHODS:

We conducted a retrospective review of patients enrolled in a primary care-based buprenorphine program between January 2011-April 2013. We describe three clinical visits types: no disclosure of opioid/cocaine use and positive UDT; disclosure of opioid or cocaine use and a negative or positive UDT; and no disclosure of opioid or cocaine use and a negative UDT. We fit generalized estimating equations logistic regression models to evaluate whether treatment time is associated with non-disclosure of opioids or cocaine use and a positive UDT.

RESULTS:

Among all UDT results (n = 1755) from 130 patients, 10% were positive for illicit opioids and 4% for cocaine. Among UDTs with illicit opioid or cocaine positive results, in 57% and 76% of these scenarios, the patient did not disclose. The odds of non-disclosure and having a positive UDT was higher in the first 180 days for opioids and 90 days for cocaine.

CONCLUSION:

Among primary care patients treated with buprenorphine, a small but substantial percentage of UDTs were cocaine or opioid positive. As treatment time increased, non-disclosure was less common but persisted even after six months. Among primary care patients treated with buprenorphine, UDTs contribute information to optimize clinical care.

KEYWORDS:

Buprenorphine; Cocaine; Opioids; Urine drug testing

PMID:
30290291
PMCID:
PMC6291245
[Available on 2019-11-01]
DOI:
10.1016/j.drugalcdep.2018.08.010

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