Buprenorphine Drastically Reduces Nonprescribed Substance Use Among Patients

A study of patients who were prescribed buprenorphine for the treatment of opioid use disorder found that those whose who tested negative for buprenorphine in urine drug tests were 10 times more likely to test positive for heroin and 7 times more likely to test positive for fentanyl.

The study was led by Brendan Saloner, PhD, an associate professor with Johns Hopkins Bloomberg School of Public Health, and co-authored by researchers from Millennium Health. Findings were published this week on JAMA Network Open.

The researchers analyzed 150,000 urine drug test results for OUD patients who were prescribed buprenorphine between 2013 and 2019. Overall, 85.49% of specimens were positive for buprenorphine, and 47.58% were positive for at least 1 non-prescribed substance. In general, those who tested negative for prescribed buprenorphine “were significantly more likely” to test positive for other substances vs. those tested positive for their prescribed buprenorphine, according to the study.

Nonprescribed substance use patterns varied widely among patients studied. For example, fentanyl positivity rates were highest among: men, patients between the ages of 18 and 24, those living in the New England area, and those with Medicaid. Oxycodone-positive tests, meanwhile, were observed more frequently among women, patients over the age of 55, those in the South Atlantic region of the US, and those with private insurance.

In their conclusion, the researchers noted that their findings highlight the utility of urine drug testing data in public health surveillance efforts related to patients being treated for OUD with buprenorphine, and that continuing to update such data “can help to identify opportunities for interventions and insights into the rapidly evolving patterns of substance use among this patient population.”