Patients seeking opioid use treatment increasingly test positive for illicit drug co-use
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Key takeaways:
- People seeking treatment for opioid use disorder tested positive for illicit drug co-use more frequently in 2021 compared with 2017.
- Heroin and fentanyl positivity decreased over 1 year of methadone treatment.
From 2017 to 2021, people seeking treatment for opioid use disorder increasingly tested positive for fentanyl, methamphetamine and cocaine at presentation, according to findings published in Addiction.
However, over 1 year of methadone treatment for opioid use disorder (OUD), heroin and fentanyl positivity decreased, data showed.
Brendan Saloner, PhD, Bloomberg Associate Professor of American Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues retrospectively reviewed the results of urine drug tests recorded in the Millennium Health database from 2017 to 2021. For analyses, the researchers included test results for adults diagnosed with opioid abuse or dependence who were receiving methadone at substance use treatment clinics, who tested positive for methadone and who provided at least three urine samples for testing.
The researchers analyzed 194,333 specimens from 16,386 patients in 10 states. Compared with samples collected at initial presentation for OUD treatment in 2017, specimens collected at initial encounters in 2021 were significantly more likely to test positive for fentanyl (13.1% vs. 53%; P < .001), methamphetamine (10.6% vs. 27.2%; P < .001) and cocaine (13.8% vs. 19.5%; P < .001). There were no significant differences in the percentage of initial encounter specimens testing positive for heroin in 2017 compared with 2021 (6.9% vs. 6.5%).
Analyses of specimen positivity over 1 year of methadone treatment for OUD indicated that 17.1% of specimens tested positive for fentanyl at week 52 compared with 21.8% at week 1 (adjusted incidence rate ratio [aIRR] = 0.78; 95% CI, 0.75-0.82). Specimen positivity for heroin also decreased from 8.4% at week 1 to 4.3% at week 52 (aIRR = 0.51; 95% CI, 0.41-0.63).
Notably, the greatest decreases in heroin and fentanyl positivity occurred within the first 10 weeks of methadone treatment, the researchers wrote.
There were no significant differences in methamphetamine or cocaine positivity over 1 year of treatment.
“Methadone treatment can have tremendous success reducing fentanyl and heroin use in individuals, but this study shows we aren’t addressing the complexity of polysubstance use,” Saloner said in a press release. “The findings clearly sound an alarm bell that we need more tools to support other types of substance use.”
References:
- Fentanyl, heroin use substantially decline in patients receiving methadone treatment for opioid use\disorder during first year. https://www.eurekalert.org/news-releases/988678. Published May 9, 2023. Accessed May 17, 2023.
- Saloner B, et al. Addiction. 2023;doi:10.1111/add.16180.