Using Client's Routine Urinalysis Records From Multiple Treatment Systems to Model Five-Year Opioid Substitution Treatment Outcomes

ABSTRACT

Background: At global, national, and local level, the need for ongoing, timely and cost efficient, comprehensive drug treatment monitoring, and evaluation systems have clearly been well recognized. Objectives: To test the feasibility of linking laboratory data and client intake data and its usefulness for modeling retrospectively, for the first time, 5-year longitudinal drug treatment outcomes in an Irish opiate treatment setting. Methods: A multisite, retrospective, longitudinal cohort study was implemented to evaluate outcomes for opiate users based on 1.7 million routine urinalysis results collected from 4,518 individuals presenting for opioid substitution treatment in Ireland from January 2006 to December 2010. Results: Analysis of opiates, cocaine, benzodiazepine, and cannabis use at treatment intake, 6 months and at 1–5 year follow-ups revealed differences in urinalysis protocols; significant differences in age of first drug use between those using and not using opiates at 5 years; significant decreases in opiate use; increases in benzodiazepine use and significant increasing effects of concurrent cocaine and benzodiazepine use on the odds of using opiates. Time series analysis of weekly proportions opiate positive predicted 16% (95% confidence interval: 7%–25%) of clients would be opiate positive 5 years postinitial intake. ConclusionsImportance: Underutilized urinalysis data can be used to address the need for cost effective, efficient evidence of drug-treatment outcomes across time, place, and systems. Linking and matching the cross-sectional data across sites and times also revealed where improvements in electronic records could be made.

KEYWORDS:

• Longitudinal evaluation
• treatment outcome
• urinalysis
• heroin
• opioid agonist treatment
• cocaine
• benzodiazepine
• patient management record systems
• Ireland

Acknowledgments

The authors would like to thank Dr. Julian Pugh, Ms. Geraldine O'Rourke, Dr. Bryon Sweeney, Dr. Des Crowley, Mr. John Pope, and Ms. Mary Fanning, who advised and assisted with the extraction of the DAIS database.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This work was supported by the Health Research Board, Ireland (Health Information Systems Award) and Trinity College Dublin (1252 PhD Scholarship).

Additional information

Notes on contributors

Catherine M. Comiskey

Catherine M. Comis-key is the current Head of School at the School of Nursing and Midwifery, Trinity College Dublin. Comiskey holds a BA (Mod) degree in Mathematics and Philosophy from Trinity College, Dublin University, Ireland and MSc and PhD degrees in biomathematics with statistics and epidemiology from Dublin City University, Ireland. In 2007, she was appointed by Minister of Education and Science to serve on the board of The Irish Research Council for Science, Engineering and Technology, (IRCSET). In 2012, she was appointed by the Minister for Health to Chair the National Advisory Committee on Drugs and Alcohol and in 2013, she was appointed by the EU to serve on the Scientific Committee of the European Monitoring Centre for Drugs and Drug Addiction. She has over 20 years of research experience in statistics and mathematics applied to healthcare. As former Director of Research and inaugural Director of the Centre for Practice and Healthcare Innovation (CPHI) and Professor of Healthcare Modeling at the School of Nursing and Midwifery, she has had responsibility for developing and implementing the School's strategic plan for research and leading on directing and promoting innovation and research in healthcare practice. Her personal research interests are in implementation, modeling of treatment and intervention outcomes with a special interest in substance misuse, infectious diseases, and children.

Anne Snel

Anne Snel, BA, BSc, PhD, DipED PGCE, graduated in Mathematics and History as her primary degree, followed by a higher diploma in education, from University College Dublin, Ireland. She immigrated to the Netherlands soon after graduating and there moved into software development. She worked for 5 years as a software developer in the financial sector in both the Netherlands and Ireland. Seven years ago, she decided to upgrade her skills and did a further 1-year course in Pure Mathematics in the Dublin Institute of Technology. Having achieved good results there, she was awarded a scholarship to pursue a PhD in mathematical and statistical modeling of cocaine use in Trinity College Dublin, Ireland.