Friday, July 28, 2023

Urine Drug Screens as Part of OUD Treatment Can Be Successfully Managed Via Telehealth

Urine drug screening of people in treatment for opioid use disorder (OUD) is feasible and reliable via telehealth, according to a study published today in JAMA Health Forum.

“This cohort study’s findings … are 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,” wrote Arthur Robin Williams, M.D., M.B.E., of Columbia University and colleagues. Williams is also chief medical officer of Ophelia, a telehealth-based OUD treatment platform available in 14 states.

Williams and colleagues analyzed data from 3,395 adults (primarily in New York and Pennsylvania) who initiated buprenorphine treatment via Ophelia between January 1, 2021, and June 6, 2022. As part of Ophelia’s virtual care model, participants were periodically sent urine drug screening kits that they used off-screen during an appointment and then showed the results to a clinician. The protocol recommended that the first test occur one week after starting buprenorphine with periodic follow-ups as patients progressed from stabilization to maintenance treatment.

Overall, 81.9% of the patients completed a drug screen within the first 30 days of care. Among patients who remained in treatment for at least 90 days, 97.6% completed at least one drug screen. Patients under 30, racial and ethnic minority patients, patients living in urban areas, and cash-pay patients were less likely to complete a drug screen within 30 days.

By 180 days, the positivity rate for buprenorphine had risen to 98.4% from a baseline of 96.9%, while opioid positivity dropped to 3.3% from a baseline of 7.9%; positive tests for cocaine and benzodiazepines also dropped significantly from baseline rates.

“Although TBOT [telehealth-based opioid treatment] has demonstrated the potential to extend treatment access to underserved areas, our findings that early UDS completion varied across demographic subgroups suggests that further study of UDS in remote care settings is warranted,” the authors wrote. “It is … important for [telehealth] platforms to consider the complex interplay between clinical suitability for remote care and socioeconomic and digital barriers.”

To read more on this topic, see the Psychiatric News article “APA Responds to DEA’s Proposed Rules Regarding Telehealth, Buprenorphine.”

(Image: iStock/Lothar Drechsel)

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