{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T03:04:18Z","timestamp":1783220658404,"version":"3.54.6"},"reference-count":21,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:00:00Z","timestamp":1683590400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA045800"],"award-info":[{"award-number":["R01DA045800"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011959","name":"Institute of Development and Economic Alternatives","doi-asserted-by":"publisher","award":["CIN 13\u2010414"],"award-info":[{"award-number":["CIN 13\u2010414"]}],"id":[{"id":"10.13039\/501100011959","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Patients in methadone medication treatment for opioid use disorder (M\u2010MOUD) typically have a complex history of opioid use, often in combination with other drugs. It is unknown how frequently M\u2010MOUD patients experience persistent substance or polysubstance use. We measured trends in illicit substance use in a large, multistate population of M\u2010MOUD patients and persistence of substance use in the first year of treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study of United States (US) M\u2010MOUD patients from 2017 to 2021, focused on urine drug specimens provided for testing to Millennium Health, a third\u2010party laboratory. Specimens were analyzed using liquid chromatography\u2013tandem mass spectrometry (LC\u2010MS\/MS). Generalized estimating equations (GEE) were used to estimate the average trends in positivity during time in treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Specimens were obtained from clinics in 10 US states that provided at least 300 unique patients during the study period (Alaska, Arizona, Florida, Illinois, Kentucky, Minnesota, New Mexico, Ohio, Virginia and Washington).<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Patients with opioid use disorder receiving M\u2010MOUD (<jats:italic>n<\/jats:italic>\u2009=\u200916\u2009386).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Positivity rates for heroin, fentanyl, methamphetamine and cocaine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>From 2017 to 2021, yearly crude positivity rates for first collected specimens increased for fentanyl (13.1%\u201353.0%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), methamphetamine (10.6%\u201327.2%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and cocaine (13.8%\u201319.5%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001); for heroin positivity did not significantly change (6.9%\u20136.5%, <jats:italic>P<\/jats:italic>\u2009=\u20090.74). In regression models estimating patient trajectories from week 1 to week 52, marginal fentanyl positivity declined from 21.8% to 17.1% (incidence rate ratio [IRR]\u2009=\u20090.78, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and heroin positivity declined from 8.4% to 4.3% (IRR\u2009=\u20090.51, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), but positivity for methamphetamine and cocaine did not significantly change, remaining at an average of 17.7% (IRR\u2009=\u20090.98, <jats:italic>P<\/jats:italic>\u2009=\u20090.53) and 9.2% (IRR\u2009=\u20090.96, <jats:italic>P<\/jats:italic>\u2009=\u20090.36), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Between 2017 and 2021, United States patients presenting to opioid treatment programs increasingly tested positive for fentanyl, methamphetamine and cocaine. Methadone medication treatment for opioid use disorder appears to remain an effective intervention for reducing illicit opioid use.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16180","type":"journal-article","created":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T17:06:43Z","timestamp":1683738403000},"page":"1549-1556","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Polydrug use among patients on methadone medication treatment: Evidence from urine drug testing to inform patient safety"],"prefix":"10.1111","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9013-3023","authenticated-orcid":false,"given":"Brendan","family":"Saloner","sequence":"first","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penn","family":"Whitley","sequence":"additional","affiliation":[{"name":"Millennium Health  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Dawson","sequence":"additional","affiliation":[{"name":"Millennium Health  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Passik","sequence":"additional","affiliation":[{"name":"Millennium Health  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam J.","family":"Gordon","sequence":"additional","affiliation":[{"name":"University of Utah and Veterans Health Administration  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley D.","family":"Stein","sequence":"additional","affiliation":[{"name":"RAND Corporation  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/09595239400185431"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2015.12.031"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-018-4801-3"},{"key":"e_1_2_10_5_1","volume-title":"Federal regulation of methadone treatment","author":"Institute of Medicine (US) Committee on Federal Regulation of Methadone Treatment","year":"1995"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108552"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108288"},{"key":"e_1_2_10_8_1","volume-title":"Federal guidelines for opioid treatment programs","author":"Substance Abuse and Mental Health Services Administration","year":"2015"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1300\/J069v26n01_08"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/10550490050172218"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000166"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","unstructured":"MattickRP BreenC KimberJ DavoliM.Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. 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