Abstract
Background: Treatment guidelines recommend regular urine drug testing (UDT) for persons initiating buprenorphine for opioid use disorder (OUD). However, little is known about UDT utilization. We describe state variation in UDT utilization and examine demographic, health, and health care utilization factors associated with UDT in Medicaid. Methods: We used Medicaid claims and enrollment data from persons initiating buprenorphine treatment for OUD during 2016–2019 in 9 states (DE, KY, MD, ME, MI, NC, PA, WI, WV). The main outcome was at least 1 UDT within 180 days of buprenorphine initiation, the secondary outcome was at least 3. Logistic regression models included demographics, pre-initiation comorbidities, and health service use. State estimates were pooled using meta-analysis. Results: The study cohort included 162,437 Medicaid enrollees initiating buprenorphine. The percent receiving ≥1 UDT varied from 62.1% to 89.8% by state. In the pooled analysis, enrollees with pre-initiation UDT had much higher odds of ≥1 UDT after initiation (aOR=3.83, 3.09–4.73); odds were also higher for enrollees with HIV, HCV, and/or HBV infection (aOR=1.25, 1.05–1.48) or who initiated in later years (2018 v 2016: aOR=1.39, 1.03–1.89; 2019 v 2016: aOR=1.67, 1.24–2.25). The odds of having ≥3 UDT were lower with pre-initiation opioid overdose (aOR=0.79, 0.64–0.96) and higher with pre-initiation UDT (aOR=2.63, 2.13–3.25) or OUD care (aOR=1.35, 1.04–1.74). The direction of associations with demographics varied by state. Conclusions: Rates of UDT increased over time and there was variability among states in UDT rates and demographic predictors of UDT. Pre-initiation conditions, UDT, and OUD care were associated with UDT.
Original language | English (US) |
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Article number | 110875 |
Journal | Drug and Alcohol Dependence |
Volume | 250 |
DOIs | |
State | Published - Sep 1 2023 |
Funding
The National Institute for Drug Abuse (R01DA048029) funded this project. NIDA had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. JD, MJ, JYK, and MS also received funding for unrelated work from the Pennsylvania Department of Human Services through an intergovernmental agreement. The National Institute for Drug Abuse ( R01DA048029 ) funded this project. NIDA had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. JD, MJ, JYK, and MS also received funding for unrelated work from the Pennsylvania Department of Human Services through an intergovernmental agreement.
Keywords
- Buprenorphine
- Drug testing
- Medicaid
- Opioid use disorder
- Overdose
- Urinalysis
ASJC Scopus subject areas
- Toxicology
- Pharmacology
- Psychiatry and Mental health
- Pharmacology (medical)