Large Variation in Provincial Guidelines for Urine Drug Screening During Opioid Agonist Treatment in Canada

Abstract Background The cascade of care framework is an effective way to measure attrition at various stages of engagement in Opioid Agonist Treatment (OAT). The primary objective of the study was to describe the cascade of care for individuals who have accessed OAT from a network of specialized addiction clinics in Ontario, Canada. The secondary objectives were to evaluate correlates associated with retention in OAT at various stages and the impact of patients' location of the residence on retention in OAT. Design: A multi-clinic retrospective cohort study was conducted using electronic medical record (EMR) data from the largest network of OAT clinics in Canada (70 clinics) from 2014-2020. Study participants included all individuals who received OAT from the network of clinics during the study period. Measurements: In this study, four stages of the cascade of care framework were operationalized to identify treatment engagement patterns, including patients retained within 90 days, 90 to 365 days, one to two years, and more than two years. Correlates associated with OAT retention for 90 days, 90 to 365 days, one to two years, and more than two years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 individuals were included in the study. Compared to individuals who were retained in OAT for 90 days, individuals who were retained for 90 to 365 days, one to two years, or more than two years were more likely to have a higher number of treatment attempts, a higher number of average monthly urine drug screening and a lower proportion of positive urine drug screening results for other drug use. Conclusion Distinct sociodemographic and clinical factors are likely to influence treatment retention at various stages of engagement along the OAT continuum. Research is required to determine if tailored strategies specific to people at different stages of engagement have the potential to improve outcomes of OAT.

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Negative Impact of Amphetamine-Type Stimulant Use on Opioid Agonist Treatment Retention in Ontario, Canada

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.782066 ◽

2021 ◽

Vol 12 ◽

Author(s):

Kristen A. Morin ◽

Frank Vojtesek ◽

Shreedhar Acharya ◽

David C. Marsh

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Drug Screening ◽

Urban Areas ◽

Logistic Regression Model ◽

Opioid Agonist ◽

Stimulant Use ◽

Urine Drug ◽

The Impact ◽

Urine Drug Screening

Objective: The objective of this study was to evaluate epidemiological trends of co-use patterns of amphetamine-type stimulants and opioids and the impact of co-use patterns on Opioid Agonist Treatment (OAT) retention in Ontario, Canada. The secondary objective was to assess geographical variation in amphetamine-type stimulant use in Northern Rural, Northern Urban, Southern Rural and Southern Urban Areas of Ontario.Methods: A retrospective cohort study on 32,674 adults receiving OAT from ~70 clinics was conducted between January 1, 2014, and December 31, 2020, in Ontario, Canada. Patients were divided into four groups base on the proportion of positive urine drug screening results for amphetamine-type stimulants during treatment: group 1 (0–25%), group 2 (25–50%), group 3 (50–75%), and groups 4 (75–100%). A Fractional logistic regression model was used to evaluate differences over time in amphetamine-type stimulant use with urine drug screening results. A Cox Proportional Hazard Ratio model was used to calculate the impact of amphetamine-type stimulant use on retention in OAT and adjusted for sociodemographic characteristics, drug use and clinical factors. Lastly, a logistic regression model was used on a subgroup of patients to assess the impact of geography on amphetamine-type stimulant use in Northern Rural, Northern Urban, Southern Rural and Southern Urban Areas of Ontario.Results: There were significant differences in amphetamine-type stimulant positive urine drug screening results year-over-year from 2015 to 2020. Significant differences were observed between amphetamine-type stimulant groups with regards to sociodemographic, clinical and drug use factors. Compared to those with no amphetamine-type stimulant use, the number of days retained in OAT treatment for amphetamine-type stimulant users was reduced (hazard ratio 1.19; 95% confidence interval = 1.07–1.17; p < 0.001). Lastly, an adjusted logistic regression model showed a significant increase in the likelihood of amphetamine-type stimulant use in Northern Rural regions compared to Southern Urban areas.Conclusion: There was a significant increase in amphetamine-type stimulant use among individuals in OAT from 2014 to 2020, associated with decreased OAT retention. Research is required to determine if tailored strategies specific to individuals in OAT who use amphetamine-type stimulants can improve OAT outcomes.

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Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy

International Journal of Drug Policy ◽

10.1016/j.drugpo.2018.08.006 ◽

2019 ◽

Vol 64 ◽

pp. 30-33 ◽

Cited By ~ 5

Author(s):

Jasmine McEachern ◽

Lauren Adye-White ◽

Kelsey C. Priest ◽

Eloise Moss ◽

Lauren Gorfinkel ◽

...

Keyword(s):

Health Outcomes ◽

Drug Screening ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Urine Drug ◽

Urine Drug Screening

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Urine Drug Screening

Diagnostic Innovation ◽

10.2165/00024666-200111000-00004 ◽

2001 ◽

Vol 11 (3) ◽

pp. 18???22

Author(s):

Albert Jekelis

Keyword(s):

Drug Screening ◽

Urine Drug ◽

Urine Drug Screening

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Is this urine really negative? A systematic review of tampering methods in urine drug screening and testing

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2006.11.008 ◽

2007 ◽

Vol 33 (1) ◽

pp. 33-42 ◽

Cited By ~ 83

Author(s):

William B. Jaffee ◽

Elisa Trucco ◽

Sharon Levy ◽

Roger D. Weiss

Keyword(s):

Systematic Review ◽

Drug Screening ◽

Urine Drug ◽

Urine Drug Screening

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O30: Comparing the performance of HR-TOFMS and immunoassay for urine drug screening

Toxicologie Analytique et Clinique ◽

10.1016/s2352-0078(14)70038-1 ◽

2014 ◽

Vol 26 (2) ◽

pp. S18

Author(s):

M. Sundström ◽

A. Pelander ◽

I. Ojanperä

Keyword(s):

Drug Screening ◽

Urine Drug ◽

Urine Drug Screening

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Urine Drug Screening in the Era of Designer Benzodiazepines: Comparison of Three Immunoassay Platforms, LC-QTOF-MS, and LC-MS/MS

Journal of Analytical Toxicology ◽

10.1093/jat/bkab108 ◽

2021 ◽

Author(s):

Andrii Puzyrenko ◽

Dan Wang ◽

Randy Schneider ◽

Greg Wallace ◽

Sara Schreiber ◽

...

Keyword(s):

Drug Screening ◽

Forensic Toxicology ◽

Confirmatory Testing ◽

Urine Drug ◽

Screening Assays ◽

Us Fda ◽

Urine Specimens ◽

Abbott Architect ◽

Designer Benzodiazepines ◽

Urine Drug Screening

ABSTRACT This study investigated the presence of designer benzodiazepines in 35 urine specimens obtained from emergency department patients undergoing urine drug screening. All specimens showed apparent false-positive benzodiazepine screening results (i.e., confirmatory testing using a 19-component LC-MS/MS panel showed no prescribed benzodiazepines at detectable levels). The primary aims were to identify the possible presence of designer benzodiazepines, characterize the reactivity of commercially available screening immunoassays with designer benzodiazepines, and evaluate the risk of inappropriately ruling out designer benzodiazepine use when utilizing common urine drug screening and confirmatory tests. Specimens were obtained from emergency departments of a single US Health system. Following clinically ordered drug screening using Abbott ARCHITECT c assays and lab-developed LC-MS/MS confirmatory testing, additional characterization was performed for investigative purposes. Specifically, urine specimens were screened using two additional assays (Roche cobas c502, Siemens Dimension Vista) and LC-QTOF-MS to identify presumptively positive species, including benzodiazepines and non-benzodiazepines. Finally, targeted, qualitative LC-MS/MS was performed to confirm the presence of 12 designer benzodiazepines. Following benzodiazepine detection using the Abbott ARCHITECT, benzodiazepines were subsequently detected in 28/35 and 35/35 urine specimens, respectively, using Siemens and Roche assays. LC-QTOF-MS showed the presumptive presence of at least one non-FDA approved benzodiazepine in 30/35 specimens: flubromazolam (12/35), flualprazolam (11/35), flubromazepam (2/35), clonazolam (4/35), etizolam (9/35), metizolam (5/35), nitrazepam (1/35), and pyrazolam (1/35). Two or three designer benzodiazepines were detected concurrently in 13/35 specimens. Qualitative LC-MS/MS confirmed the presence of at least one designer benzodiazepine or metabolite in 23/35 specimens, with 3 specimens unavailable for confirmatory testing. Urine benzodiazepine screening assays from three manufacturers were cross-reactive with multiple non-US FDA-approved benzodiazepines. Clinical and forensic toxicology laboratories using traditionally designed LC-MS/MS panels may fail to confirm the presence of non-US FDA-approved benzodiazepines detected by screening assays, risking inappropriate interpretation of screening results as false-positives.

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