Use of psychotropic drug urine test strips in opiate maintenance therapy: A clinical assessment of its advantages

ABSTRACT

Background: Methadone and buprenorphine are the 2 opiate maintenance treatments (OMTs) available in France. According to good clinical practices, a full clinical and biological assessment is required before deciding to initiate or renew an OMT. For methadone, this assessment includes psychoactive drug consumption investigation through an initial interview completed by a systematic urine test mandatory before starting methadone treatment. In case of buprenorphine prescription, the situation is less clear and the urine test was not systematically performed. This work aims at evaluating changes in the therapeutic strategy brought by the systematic use of urine strips for detecting drug consumptions. Methods: During 1 month, for each case of OMT renewal, physicians belonging to the 3 types of prescribing structures in France (general medicine, specialized centers for drug addict patients, and specialized centers for drug addict patients in prison) had to complete a specific questionnaire about prescription renewal. This questionnaire contained 2 parts. The first part was completed by the physicians before the urine test strip realization. The second part was completed by the same physicians at the end of the consultation, after obtaining the results from the urine test strip. A change between parts 1 and 2 of the questionnaire concerning OMT prescription, dialogue with the patient, associated psychotropic drug prescription, and orientation were considered as a change in therapeutic strategy. Results: A total of 429 questionnaires have been collected. Among them, 315 showed at least 1 change in therapeutic strategy (73.4%). Conclusions: This study highlighted the important benefits brought by the urine test strip in managing patients under opiate maintenance treatment. Urine test strips provided an immediate answer that allowed physicians to optimize their therapeutic strategy. However, regulatory evolutions would be necessary to ease their implantation.

KEYWORDS:

• Buprenorphine
• methadone
• opiate dependence
• opiate maintenance treatment
• urine test strips

Acknowledgments

Urine test strips were provided by the Nantes Addictology Network. No other funding was received. The design, conduct of the study, management, analysis, interpretation of the data, and all concerns about the manuscript were managed by the Department of Clinical Pharmacology, Center for Evaluation and Information on Pharmacodependence, Nantes University Hospital. Dr. Jean Yves Guillet, addictology network coordonator, has participated in all meeting of the steering committee of this work, as a consultative advice. All authors declare that they have no conflicts of interest.

Author contributions

Caroline Victorri-Vigneau, Morgane Rousselet, Emeric Belliot, Marylène Guerlais, and Jean-Yves Guillet designed the study, wrote the protocol, and conducted the statistical analysis. Regis Bouquié, Marie Grall-Bronnec, and Pascale Jolliet conducted literature searches and assess the scientific quality of the work. Caroline Victorri-Vigneau and Morgane Rousselet wrote the first draft of the manuscript, and all authors contributed to and have approved the final manuscript.