Remote Urine Drug Screening Feasible for Opioid Use Disorder, Study Shows

Remotely administered urine drug screening was found to be feasible in patients with opioid use disorder (OUD) who were receiving buprenorphine in remote care settings, according to a cohort study.

Of more than 3,000 patients in the study cohort, 83.3% completed a urine drug screening within the first 30 days (90.0% among protocol-adherent patients and 67.0% among protocol-nonadherent patients) of their inclusion in a virtually managed OUD treatment program, reported Arthur Robin Williams MD, MBE, chief medical officer of Ophelia Health in New York City, a telehealth-based opioid treatment provider, and co-authors.

Among the 2,314 patients who remained in the program for 180 days, 99.7% completed at least one drug screening, with a median number of three screenings per patient, the team noted in JAMA Health Forum.

The researchers also found that buprenorphine positivity increased from 96.9% to 98.4% (P=0.004) and opioid positivity decreased from 7.9% to 3.3% (P<0.001) among patients who remained in the program for 180 days and had both baseline and follow-up urine drug screenings.

They said that certain groups, including younger patients, racial and ethnic minority patients, and patients in urban areas, were less likely to complete a drug screening in the first 30 days of the study period.

The results, Williams and co-authors concluded, were "consistent with the premise that long-standing and stringent requirements (e.g., requiring in-person visits, frequent drug testing) for being prescribed buprenorphine for OUD can be relaxed without jeopardizing the quality or safety of care for many patients."

In an email to MedPage Today, Williams wrote that "there is a consensus among federal health agencies that telehealth has been a breakthrough in scaling access to affordable, high-quality care for OUD amid a 25-plus-year opioid crisis. Law enforcement and insurance plans, however, have concerns about the safety of telehealth treatment platforms. Our study confirms that the use of drug testing in remote care can be equivalent to that of in-person settings."

He added that drug testing can improve clinical outcomes for patients in OUD treatment when used to support a patient's goals for their care, and the results of the study show that this is also true for OUD treatment using a telehealth platform.

"The DEA [Drug Enforcement Administration] requires that buprenorphine prescribers have a diversion management plan," Williams noted. "Although they do not mandate the use of drug testing, it is within the standard of care to use drug testing to confirm a patient is consistently taking their medication. In this case, we are empirically demonstrating that routine drug testing can be feasibly conducted in an exclusively telehealth care environment."

In addition, he said, the disparity in the adherence to the protocols in the study reflect the real-world challenges faced by patients with OUD and their healthcare providers. For example, younger patients and racial and ethnic minority patients often experience inferior clinical outcomes because they typically face more obstacles to accessing healthcare services as a result of social drivers of health.

To conduct the study, Williams and colleagues selected patients with OUD who were treated through Ophelia Health. All patients had to be English-speaking adults, meet the DSM-5 criteria for OUD, and not require high levels of additional healthcare, such as having unmanaged psychiatric conditions.

Participants were included in the study from January 2021 to June 2022, and received their first buprenorphine dose within 7 days of intake. The urine drug screenings included two 16-panel kits -- the Know Drug Test Cup kit or the T-Cup Compact kit -- that were sent to each patient, and additional kits were sent as needed.

The patients followed a clinical protocol that required them to complete one screening per week after intake for 4 weeks, and then one screening every other week. If patients remained in the program, they eventually moved to have one screening a month and then one screening each quarter.

The screenings were self-administered off-screen during telehealth visits. The patient's healthcare provider would then visually inspect the results and discuss them with the patient over video in real-time. The validity of each urine sample was assessed by confirming that several measurements were within normal range, including temperature, creatinine, and pH.

Among the 3,395 patients included in the analysis, the majority were male (54.1%), non-Hispanic white (81.5%), and lived in urban areas (80.3%). They had a mean age of 38.2 years, and 74% payed for the services without insurance at intake.

Study limitations, Williams and team said, included that patients in telehealth-based opioid treatment settings may not be representative of all patients with OUD, and that remote urine drug screening could be more vulnerable to sample tampering than in-person screening.

In addition, the rate of opioid positivity in the study sample was substantially lower than that observed in in-person office-based opioid treatment settings, thus raising questions about how the populations may differ. Also, if patients not completing a urine drug screening were more likely to use opioids (i.e., if clinicians were less likely to administer the screenings to patients who spoke openly about recent drug use), the rates observed may underestimate the true rates of opioid positivity.

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