Trends in drug use from urine drug testing of addiction treatment clients

Authors

  • Kenneth L. Kirsh, PhD
  • Howard A. Heit, MD
  • Angela Huskey, PharmD, CPE
  • Jennifer Strickland, PharmD, BCPS
  • Kathleen Egan City, MA, BSN, RN
  • Steven D. Passik, PhD

DOI:

https://doi.org/10.5055/jom.2015.0253

Keywords:

addiction, urine drug testing, relapse, monitoring

Abstract

Objective: Urine drug testing (UDT) can play an important role in the care of patients in recovery from addiction, and it has become necessary for providers and programs to utilize specific, accurate testing beyond what immunoassay (IA) provides.

Design: A database of addiction treatment and recovery programs was sampled to demonstrate national trends in drug abuse and to explore potential clinical implications of differing results due to the type of testing utilized.

Setting: Deidentified data was selected from a national laboratory testing company that had undergone liquid chromatography tandem mass spectrometry (LCMS/MS).

Patients/Participants: A total of 4,299 samples were selected for study.

Interventions: Descriptive statistics of the trends are presented.

Results: In total, 48.5 percent (n = 2,082) of the samples were deemed in full agreement between the practice reports and the results of LC-MS/MS testing. The remaining 51.5 percent of samples fell into one of seven categories of unexpected results, with the most frequent being detection of an unreported prescription medication (n = 1,097).

Conclusions: Results of UDT demonstrate that more than half of samples yield unexpected results from specimens collected in addiction treatment. When comparing results of IA and LC-MS/MS, it is important to consider the limits of IA in the detection of drug use by these patients.

Author Biographies

Kenneth L. Kirsh, PhD

Millennium Research Institute, San Diego, California; Vice President, Clinical Research and Advocacy, Millennium Health, San Diego, California.

 

Howard A. Heit, MD

Georgetown University School of Medicine, Washington, DC.

Angela Huskey, PharmD, CPE

Millennium Research Institute, San Diego, California; Millennium Health, San Diego, California.

Jennifer Strickland, PharmD, BCPS

Millennium Research Institute, San Diego, California.

Kathleen Egan City, MA, BSN, RN

Millennium Research Institute, San Diego, California; Millennium Health, San Diego, California.

Steven D. Passik, PhD

Millennium Research Institute, San Diego, California; Vice President, Clinical Research and Advocacy, Millennium Health, San Diego, California.

 

References

Substance Abuse and Mental Health Services Administration (SAMHSA): Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

Government Accountability Office: Government Accountability Office (GAO) Report, Medicare Part D: Instances of questionable access to prescription drugs, September 2011. Available at http://www.gao.gov/new.items/d11699.pdf. Accessed March 12, 2014.

Testimony of Jonathan Blum before U.S. Senate Committee on Homeland Security and Government Affairs. Available at http://www.hhs.gov/asl/testify/2013/06/4483.html. Accessed March 12, 2014.

White AG, Birnbaum HG, Mareva MN, et al.: Direct costs of opioid abuse in an insured population in the United States. J Manag Care Pharm. 2005; 11(6): 469-479. DOI: https://doi.org/10.18553/jmcp.2005.11.6.469

Birnbaum HG, White AG, Reynolds JL, et al.: Estimated costs of prescription opioid analgesic abuse in the United States in 2001: A societal perspective. Clin J Pain. 2006; 22(8): 667-676. DOI: https://doi.org/10.1097/01.ajp.0000210915.80417.cf

Birnbaum HG, White AG, Schiller M, et al.: Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011; 12(4): 657-667. DOI: https://doi.org/10.1111/j.1526-4637.2011.01075.x

Hansen RN, Oster G, Edelsberg J, et al.: Economic costs of nonmedical use of prescription opioids. Clin J Pain. 2011; 27(3): 194-202. DOI: https://doi.org/10.1097/AJP.0b013e3181ff04ca

American Society of Addiction Medicine (ASAM): Public policy statement on drug testing as a component of addiction treatment and monitoring programs and in other clinical settings. Adopted July 2002, revised 2010. Available at http://www.asam.org/docs/publicy-policy-statements/1drug-testing---clinical-10-10.pdf?sfvrsn=0#search=“urine”. Accessed October 8, 2013.

National Institute on Drug Abuse (NIDA): Principles of addiction treatment: A research based guide. NIH Publication No. 99-4180. National Institute on Drug Abuse, October 1999. Available at http://www.drugabuse.gov/publications/principlesdrug-abuse-treatment-criminal-justice-populations/principles. Accessed January 5, 2015.

Tenore PL: Advanced urine toxicology testing. J Addict Dis. 2010; 29(4): 436-448. DOI: https://doi.org/10.1080/10550887.2010.509277

Sullivan MA, Birkmayer F, Boyarsky BK, et al.: Uses of coercion in addiction treatment: Clinical aspects. Am J Addict. 2008; 17(1): 36-47. DOI: https://doi.org/10.1080/10550490701756369

Davstad I, Stenbacka M, Leifman A, et al.: Patterns of illicit drug use and retention in a methadone program: A longitudinal study. J Opioid Manag. 2007; 3(1): 27-34. DOI: https://doi.org/10.5055/jom.2007.0036

Substance Abuse and Mental Health Services Administration (SAMHSA): Results from the 2010 national survey on drug use and health: Summary of national findings. US Department of Health and Human Services, Sept 2011. Available http://www.oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.pdf. Accessed October 8, 2013.

Atluri S, Sudarshan G, Manchikanti L: Assessment of the trends in medical use and misuse of opioid analgesics from 2004 to 2011. Pain Physician. 2014; 17(2): E119-E128. DOI: https://doi.org/10.36076/ppj.2014/17/E119

Lavonas EJ, Severtson SG, Martinez EM, et al.: Abuse and diversion of buprenorphine sublingual tablets and film. J Subst Abuse Treat. 2014; 47(1): 27-34. DOI: https://doi.org/10.1016/j.jsat.2014.02.003

Bertol E, Vaiano F, Borsotti M, et al.: Comparison of immunoassay screening tests and LC-MS-MS for urine detection of benzodiazepines and their metabolites: Results of a national proficiency test. J Anal Toxicol. 2013; 37(9): 659-664. DOI: https://doi.org/10.1093/jat/bkt063

Kim JA, Ptolemy AS, Melanson SE, et al.: The clinical impact of a false-positive urine cocaine screening result on a patient's pain management. Pain Med. 2013 (in press). doi: 10.1111/pme.12265. DOI: https://doi.org/10.1111/pme.12265

Rengarajan A, Mullins ME: How often do false-positive phencyclidine urine screens occur with use of common medications? Clin Toxicol (Phila). 2013; 51(6): 493-496. DOI: https://doi.org/10.3109/15563650.2013.801982

Molfenter T, Capoccia VA, Boyle MG, et al.: The readiness of addiction treatment agencies for health care reform. Subst Abuse Treat Prev Policy. 2012; 7: 16. DOI: https://doi.org/10.1186/1747-597X-7-16

Pylkas A: Moving addiction treatment into the 21st century. Our treatment system needs an overhaul. Minn Med. 2013; 96(3): 34-35.

Sindelar J, Elbel B, Petry NM: What do we get for our money? Cost-effectiveness of adding contingency management. Addiction. 2007; 102(2): 309-316. DOI: https://doi.org/10.1111/j.1360-0443.2006.01689.x

Brensilver M, Heinzerling KG, Swanson AN, et al.: A retrospective analysis of two randomized trials of bupropion for methamphetamine dependence: Suggested guidelines for treatment discontinuation/augmentation. Drug Alcohol Depend. 2012; 125(1-2): 169-172. DOI: https://doi.org/10.1016/j.drugalcdep.2012.03.027

Olmstead TA, Sindelar JL, Easton CJ, et al.: The cost-effectiveness of four treatments for marijuana dependence. Addiction. 2007; 102(9): 1443-1453. DOI: https://doi.org/10.1111/j.1360-0443.2007.01909.x

Published

01/01/2015

How to Cite

Kirsh, PhD, K. L., H. A. Heit, MD, A. Huskey, PharmD, CPE, J. Strickland, PharmD, BCPS, K. E. City, MA, BSN, RN, and S. D. Passik, PhD. “Trends in Drug Use from Urine Drug Testing of Addiction Treatment Clients”. Journal of Opioid Management, vol. 11, no. 1, Jan. 2015, doi:10.5055/jom.2015.0253.