Drug positivity, co-detection patterns, and demographic predictors in patients seeking substance use disorder treatment, United States, 2023.

OBJECTIVE

To examine drug positivity, co-detection patterns, and demographic associations across 14 drug categories in patients seeking substance use disorder (SUD) treatment.

METHODS

This cross-sectional study analyzed 2023 urine drug testing data from Quest Diagnostics. Included were patients aged ≥ 15 years with a valid first urine drug test result ordered by SUD treatment providers. Tests screened for 14 drug categories, including fentanyl, heroin (6-acetylmorphine only), prescription opioids, stimulants, benzodiazepines, and others. Outcomes included drug positivity, paired drug co-detection, and associations with age, sex, insurance type, and geographic region using multivariable logistic regression.

RESULTS

Among 99,224 patients, most were aged 35 - 54 years (46.9%), male (62.6%), on Medicaid (48.2%) or private insurance (46.5%), and resided in the Northeast (56.3%). Buprenorphine (24.5%) and fentanyl (17.5%) had the highest positivity rates, with fentanyl frequently co-detected with other substances. Patients aged ≥ 25 years had higher odds of drug positivity (adjusted odds ratio [AOR] range: 1.3 - 9.8), except for fentanyl, methamphetamine, and amphetamine. Males had higher odds of fentanyl (AOR, 1.1) and cocaine (AOR, 1.1) positivity but lower odds for most other drugs. Medicaid beneficiaries had increased odds for multiple substances, including methadone (AOR, 3.4) and buprenorphine (AOR, 1.7), versus those with private insurance. Regional variation was notable, with higher odds for buprenorphine in the Midwest and South, but lower odds for methadone compared to the Northeast.

CONCLUSIONS

This study highlights variations in substance presence and co-detection across 14 drug categories in SUD treatment patients, underscoring the need for tailored prevention and treatment strategies.