Top 5 Takeaways
- Increase in Synthetic Opioid Overdose Deaths: Overdose deaths involving synthetic opioids, primarily illicitly manufactured fentanyl, have increased approximately tenfold since 2013 and accelerated during the COVID-19 pandemic.
- Testing Decline During Pandemic: The number of urine specimens tested for fentanyl among patients receiving and not receiving medication for opioid use disorder (MOUD) declined significantly during the early months of the pandemic.
- Peak in Positive Test Results: The percentage of positive test results for nonprescribed fentanyl among patients receiving MOUD peaked at 40.5% during March 29–April 11, 2020.
- Lower Positive Rates by End of 2020: By September–December 2020, the percentage of positive test results for nonprescribed fentanyl among patients receiving MOUD had declined to levels considerably lower than the same period in 2019.
- Need for Continued Monitoring and Care: The study highlights the urgency of continuing and expanding access to MOUD and other treatment and harm reduction services, especially given the predicted increases in opioid-involved overdoses.
Original Article Author and Citation
Corresponding Author
Justin K. Niles, Justin.K.Niles@QuestDiagnostics.com
Suggested Citation
Summary
This article discusses the trends in testing for nonprescribed fentanyl and the percentage of positive test results among patients with opioid use disorder (OUD) in the United States during 2019–2020. The study found that overdose deaths involving synthetic opioids, primarily illicitly manufactured fentanyl, have increased significantly since 2013 and accelerated during the COVID-19 pandemic. The number of urine specimens tested for fentanyl among patients receiving and not receiving MOUD declined significantly during the early months of the pandemic. The percentage of positive test results for nonprescribed fentanyl among patients receiving MOUD peaked at 40.5% during March 29–April 11, 2020, but declined to lower levels by the end of 2020.
Methods
Clinical drug monitoring of urine specimens from patients residing in all U.S. states and the District of Columbia was conducted using definitive mass spectrometry at Quest Diagnostics during 2019–2020. A positive test result for nonprescribed fentanyl was defined as the detection of norfentanyl or fentanyl not listed as prescribed. Patients receiving MOUD were identified using ICD-10-CM codes for opioid-related disorders and a positive test result for buprenorphine or methadone listed as prescribed. SAS Studio (version 3.6) was used for data analysis.
Discussion
The study found that the number of specimens tested declined significantly during the early months of the pandemic, with a peak in positive test results for nonprescribed fentanyl among patients receiving MOUD during March 29–April 11, 2020. Despite the decline in testing volume, the overall demographic proportions of patients remained similar, suggesting that the increase in positive test results was not driven by demographic shifts. The study highlights the need for continued and expanded access to MOUD and other treatment and harm reduction services, especially given the predicted increases in opioid-involved overdoses.
Conclusion
The findings underscore the importance of maintaining and expanding access to MOUD and other harm reduction services during the pandemic. The decline in drug monitoring disproportionately affected patients receiving MOUD, raising concerns about potential treatment disruptions. The study calls for intensified prevention efforts for nonprescribed fentanyl use and overdose, including the dissemination of fentanyl test strips, enhanced linkage to care, and expanded use of MOUD.
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