Drug screens early during treatment for OUD predict risk of return to opioid use

Patients whose urine drug screens in the three weeks after beginning treatment for opioid use disorder (OUD) were negative for opioids had a 13% risk of returning to opioid use compared with 85% for those with three weeks of opioid-positive or missing results.

Four factors available at entry into treatment for opioid use disorder predicted whether patients would resume using opioids during treatment, and urine drug screens during treatment were also predictive, a study found.

To develop a prediction tool for which patients treated for opioid use disorder might resume opioid use, researchers applied a decision analytical model that used predictive modeling with individual-level data from three multicenter, pragmatic, randomized clinical trials of at least 12 weeks' duration between 2006 and 2016. All 2,199 participants received methadone, buprenorphine, or extended-release naltrexone. The outcome that the researchers tried to predict was return to use, defined as four consecutive weeks of urine drug screen results that were either missing or positive for nonprescribed opioids by week 12 of treatment.

The clinical trials covered a variety of treatment settings, including federally licensed treatment sites, physician practices, and inpatient treatment facilities. The trials had few exclusion criteria except for major medical and unstable psychiatric comorbidities. The study was published by JAMA Psychiatry on Oct. 4.

Researchers developed a model based on four predictors at treatment entry: heroin use days, morphine- and cocaine-positive urine drug screen results, and heroin injection in the past 30 days. It had an area under the receiver-operating characteristic curve (AUROC) of 0.67 (95% CI, 0.62 to 0.71). Adding urine drug screen results from the first three treatment weeks improved model performance (AUROC, 0.82; 95% CI, 0.78 to 0.85). Patients with negative screening results in the three weeks after beginning treatment had a 13% risk of return to use compared with 85% for those with three weeks of opioid-positive or missing results (AUROC, 0.80; 95% CI, 0.76 to 0.84).

“Early achievement of remission is well known to predict ongoing treatment success,” the authors wrote. “Adding to existing knowledge, our results quantify this association by indicating how likely a patient is to return to opioid use. This finding might be universal: Individuals across different treatment settings, whether predominantly using prescription opioids or heroin and who were randomized to any medication, would have low return-to-use risk if they are able to sustain abstinence early.”