Urine drug testing among Medicaid enrollees initiating buprenorphine treatment for opioid use disorder within 9 MODRN states

Authors

Lindsey Hammerslag, Division of Biomedical Informatics, College of Medicine, University of Kentucky
Jeffery Talbert, Institute for Biomedical Informatics, College of Medicine, University of Kentucky
Julie M. Donahue, Health Policy and Management, University of Pittsburgh School of Public Health
Michael Sharbaugh, Department of Health Policy and Management, University of Pittsburgh School of Public Health
Katherine A. Aherns MPH, PhD, Muskie School of Public Service, University of Southern Maine
Lindsay Allen, Feinberg School of Medicine, Northwestern University,
Anna E. Austin, Gillings School of Global Public Health and Injury Prevention Research Center, University of North Carolina at Chapel Hill
Adam J. Gordon, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, Department of Internal Medicine, University of Utah School of Medicine and VA Salt Lake City Health Care System
Marian Jarlenski, Department of Health Policy and Management, University of Pittsburgh School of Public Health
Joo Yeon Kim, Department of Health Policy and Management, University of Pittsburgh School of Public Health,
Shamis Mohamoud, The Hilltop Institute, University of Maryland Baltimore County
Marguerite Burns, Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin

Document Type

Article

Publication Date

9-1-2023

Publication Title

Drug and Alcohol Dependence Volume 250, 1 September 2023, 110875

Keywords

Muskie, Faculty Scholarship, Urine Drug Testing, buprenorphine treatment, opioid use disorder

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.

Recommended Citation

Hammerslag, L., Talbert, J., Donohue, J. M., Sharbaugh, M., Ahrens, K., Allen, L., Austin, A. E., Gordon, A. J., Jarlenski, M., Kim, J. Y., Mohamoud, S., Tang, L., & Burns, M. (2023, Sept). Urine Drug Testing among Medicaid Enrollees Initiating Buprenorphine Treatment for Opioid Use Disorder within 9 MODRN States. Drug and Alcohol Dependence, 250, 110875. https://doi.org/10.1016/j.drugalcdep.2023.110875