Impact of urine drug screening on opioid agonist treatment maintenance with buprenorphine in primary care in France: A cluster-randomized trial.

INTRODUCTION

To assess the impact of onsite urine drug screening tests (OS-UDTs) in general practice compared with that of routine medical care on opioid agonist treatment (OAT) retention at six months in opioid-dependent patients initiating buprenorphine.

METHODS

In this cluster-randomized controlled trial, general practitioners (GPs) working in primary care and regularly managing patients treated with buprenorphine were invited to participate and were randomly assigned to the intervention or routine care group. GPs (cluster level) were asked to include 1-10 patients starting buprenorphine (individual level). The intervention included: (1) a training session on OS-UDTs; (2) the supply of OS-UDTs at GPs' offices; and (3) performing an OS-UDT before the first prescription of buprenorphine. The primary outcome was OAT retention at 6 months.

RESULTS

Among the 97 GPs included (intervention group: 49; control group: 48), 17 GPs included at least one patient, totaling 39 patients: 23 in the intervention group and 16 in the control group. Retention at 6 months was similar: 8 patients (34.7%) in the intervention group and 7 (43.8%) in the control group (OR=0.69 [95% CI: 0.18-2.56], P value=0.57). The patients were mainly men (69.2%), aged 39.3±11.6 years. All 13 patients in the intervention group who returned the acceptability questionnaire rated as "normal medical practice" the GP asking for OS-UDT for the management of OAT.

CONCLUSION

In the context of a recent decline in the number of patients receiving OAT, and while all participating GPs reported regularly caring for patients for OUD, this inconclusive trial faced recruitment difficulties due to the low level of buprenorphine initiation in current daily practice. Nevertheless, this trial determined the characteristics of patients starting buprenorphine in primary care and revealed that OS-UDT was acceptable.

TRIAL REGISTRATION: NCT02345655.