Agreement between self-report and urine drug test results in a sample patients treated with buprenorphine for opioid use disorder
Bagley, Sarah Mary
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BACKGROUND: Urine drug testing (UDT) is recommended to monitor primary care patients treated for opioid use disorder with buprenorphine. Whether UDT data contributes clinically useful information beyond patient self-report of drug use has received minimal attention. It is unclear whether differences between patient self-report and UDT results varies with time in treatment. OBJECTIVES: To estimate concordance between self-report and UDT results and evaluate if discordant results are associated with time in treatment. METHODS: Retrospective review of electronic medical records of patients enrolled in the Office Based Opioid Treatment program at Boston Medical Center between January 2011–April 2013. Typically, patients submit a urine sample for UDT at the beginning of a clinical visit and are subsequently asked about recent cocaine and opioid use which is documented in the electronic medical record. We compared UDT results to patient self-report of cocaine and opioid use. RESULTS: Of 1,755 UDT from 130 patients, 4% (78/1755) were positive for cocaine and 10% (157/1563) for opioids other than buprenorphine. At visits with a cocaine positive UDT, 76% of patients (59/78) did not disclose cocaine use. At visits with an opioid positive UDT, 57% of patients (89/157) did not disclose opioid use. The odds of having a positive UDT for either cocaine or opioids with no disclosure of use decreased over a year of treatment. CONCLUSION: In a sample of primary care patients with opioid use disorder treated with buprenorphine, fewer than 10% of UDTs were positive for cocaine or opioids, and in these instances patient self-reported use of cocaine or opioids less than half the time. As duration of treatment increased, patients were more likely to disclose use. Urine drug testing contributes new and useful information for clinical consideration of the optimal care of patients with drug use disorders; how best to collect and utilize this information merits further study.