Drug and alcohol dependence · 2026
Medication for opioid use disorder following urine drug testing: An observational cohort study of linked national laboratory and medical and pharmacy claims data.
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White Bradley, Skinner Jonathan, Hammonds Tracy, Bhattacharyya Partha, Ali Mir M
Аннотация
BACKGROUND AND AIMS: Urine drug testing (UDT) is commonly used in opioid use disorder (OUD) care to assess substance use and inform clinical decision-making, yet little is known about how opioid UDT results are associated with subsequent medication for opioid (MOUD) use and adherence. This study examines the association between opioid UDT, post-UDT MOUD use, and treatment adherence using linked national laboratory and medical and pharmacy claims data.
DESIGN: Retrospective quantitative observational cohort study.
SETTING: United States, using linked national laboratory and adjudicated medical and pharmacy claims data covering all 50 states and Washington DC.
PARTICIPANTS: Adults aged 18-64 years with at least one opioid UDT between June 2017 and May 2025 and continuous medical and pharmacy enrollment for 180 days prior and 365 days following the initial test (N = 759,153).
MEASUREMENT: Primary outcomes were post-UDT MOUD use within 365 days after opioid UDT and MOUD adherence. Treatment adherence was defined using claims-based gaps consistent with prior literature. Multivariable logistic regression models adjusted for demographics, insurance type, comorbid mental and physical health conditions, prior MOUD use, and state-level fixed effects.
FINDINGS: Overall, 32.1% of patients tested positive for opioid use. Post-UDT MOUD use was low (5.3% overall; 9.4% among those with positive opioid UDT). Multivariable logistic regression modeling showed that a positive opioid UDT was associated with more than twice the odds of post-UDT MOUD use (OR = 2.15; 95% CI = 2.10-2.20). However, among patients with post-UDT MOUD, positive opioid UDT was associated with lower odds of MOUD adherence (OR = 0.51; 95% CI = 0.49-0.54). Results were consistent for patients with diagnosed OUD.
CONCLUSIONS: Positive opioid UDT was associated with increased likelihood of post-UDT MOUD use but low MOUD treatment adherence. These findings highlight opportunities to strengthen sustained engagement with evidence-based treatment and underscore the need for care models that better support patients following opioid UDT, including timely MOUD use and adherence support.
DESIGN: Retrospective quantitative observational cohort study.
SETTING: United States, using linked national laboratory and adjudicated medical and pharmacy claims data covering all 50 states and Washington DC.
PARTICIPANTS: Adults aged 18-64 years with at least one opioid UDT between June 2017 and May 2025 and continuous medical and pharmacy enrollment for 180 days prior and 365 days following the initial test (N = 759,153).
MEASUREMENT: Primary outcomes were post-UDT MOUD use within 365 days after opioid UDT and MOUD adherence. Treatment adherence was defined using claims-based gaps consistent with prior literature. Multivariable logistic regression models adjusted for demographics, insurance type, comorbid mental and physical health conditions, prior MOUD use, and state-level fixed effects.
FINDINGS: Overall, 32.1% of patients tested positive for opioid use. Post-UDT MOUD use was low (5.3% overall; 9.4% among those with positive opioid UDT). Multivariable logistic regression modeling showed that a positive opioid UDT was associated with more than twice the odds of post-UDT MOUD use (OR = 2.15; 95% CI = 2.10-2.20). However, among patients with post-UDT MOUD, positive opioid UDT was associated with lower odds of MOUD adherence (OR = 0.51; 95% CI = 0.49-0.54). Results were consistent for patients with diagnosed OUD.
CONCLUSIONS: Positive opioid UDT was associated with increased likelihood of post-UDT MOUD use but low MOUD treatment adherence. These findings highlight opportunities to strengthen sustained engagement with evidence-based treatment and underscore the need for care models that better support patients following opioid UDT, including timely MOUD use and adherence support.