Comparison of Tuberculin Skin Testing Reactivity in Opioid-Dependent Patients Seeking Treatment with Methadone versus Buprenorphine: Policy Implications for Tuberculosis Screening

Abstract

Background: Buprenorphine's availability in primary care settings offers increased access to treatment and linkage to primary care for opioid-dependent patients. Currently, tuberculin skin testing (TST) is recommended for patients enrolling in methadone maintenance treatment (MMT), but not for those enrolling in buprenorphine maintenance treatment (BMT). Objectives: To compare TST screening results in enrollees in BMT and MMT programs and assess the correlates of TST positivity among these subjects. Methods: A cross-sectional analysis of a retrospective cohort study was conducted to compare concurrent TST results among contemporaneously matched groups of MMT and BMT patients in the same community. Results: TST positivity was ∼9% in both MMT and BMT settings (p = .27). Increased TST positivity was associated with being Black (AOR = 3.53, CI = 1.28–9.77), Hispanic (AOR = 3.11, CI = 1.12–8.60), and having higher education (AOR = 3.01, CI = 1.20–7.53). Conclusions: These results confirm a similar high prevalence of TST positivity in opioid-dependent patients enrolling in MMT and BMT programs. Racial and ethnic health disparities remain associated with TST positivity, yet a relationship between higher education and tuberculosis requires further investigation. Scientific significance: These data suggest the importance of incorporating TST screening in emerging BMT programs as a mechanism to provide increased detection and treatment of tuberculosis infection in opioid-dependent patient populations.

Keywords :

• Buprenorphine
• methadone
• mobile health care
• screening
• substance abuse
• tuberculosis

ACKNOWLEDGMENTS

The authors would like to thank the Substance Abuse and Mental Health Services Agency for their funding (H79 TI015767) in these clinical and research efforts as well as the National Institute on Drug Abuse (K23 DA022143 for RDB and K24 DA017072 for FLA) for career development support. Mildred Godfrey and Bob Freeman from The APT Foundation provided assistance with medical record data collection.