TOPLINE

A positive opioid urine drug test (UDT) was linked to higher odds of subsequent use of medication for opioid use disorder (MOUD) compared with a negative test, but lower odds of treatment adherence; overall, only 31% of patients who received MOUD after testing adhered to it, a study showed.

METHODOLOGY

• Researchers conducted a retrospective observational cohort study using linked national laboratory and adjudicated medical and pharmacy claims data across the US from 2017 to 2025.
• A total of 759,153 adults aged 18-64 years (62.5% women; 65.5% White individuals) with at least one opioid UDT and continuous medical and pharmacy enrollment for 180 days before and 365 days after the initial test were included.
• Researchers assessed post-UDT MOUD use within 1 year and treatment non-adherence (defined as gaps > 7 days for oral buprenorphine or naltrexone, > 45 days for injectable formulations, and > 7 days for methadone clinic visits) at 30, 90, 180, and 365 days.
• Covariates included demographics, insurance type, comorbid mental and physical health conditions, prior MOUD use, opioid use disorder (OUD) diagnoses, use of psychotropic drugs, and state-level fixed effects.

TAKEAWAY

• Overall, 32.1% of patients tested positive for opioids. MOUD use after testing was low, at 5.3% overall and 9.4% among those with a positive opioid UDT.
• After adjustment, positive opioid UDT was linked to higher odds of MOUD use after testing compared with a negative result (odds ratio [OR], 2.15; 95% CI, 2.10-2.20).
• After adjustment, among patients who received MOUD after testing, a positive opioid UDT was associated with lower odds of adherence (OR, 0.51; 95% CI, 0.49-0.54).
• Among patients with an OUD diagnosis, 18.9% of those with a positive opioid UDT received MOUD after testing vs 11.4% of those with a negative result. Overall, 15.7% of patients with an OUD diagnosis received MOUD after testing.

IN PRACTICE

"Results suggest that while opioid UDT results may identify patients who warrant further clinical assessment and consideration for evidence-based treatment, UDT results alone are insufficient to ensure sustained engagement with MOUD," the investigators wrote.

"Interventions that link UDT results to immediate treatment referral, care navigation, and adherence support are critical to improving patient outcomes and sustained MOUD use, particularly for patients with complex medical and social needs," they added.

SOURCE

The study was led by Bradley White, PhD, Division of Behavioral and Social Research at the National Institute on Aging. It was published in the November 2026 print issue of Drug and Alcohol Dependence.

LIMITATIONS

UDT did not distinguish between prescribed and nonprescribed opioid use, or capture frequency, dose, or timing of use. MOUD use and adherence were measured using pharmacy and treatment claims, which reflected medication dispensing or billing rather than actual consumption. Causal inferences could not be drawn owing to the study's observational design, and the study included only insured individuals with linked data, limiting generalizability to uninsured populations.

DISCLOSURES

The study did not receive any specific funding. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.