Evaluation of ongoing oxycodone abuse among methadone-maintained patients

Abstract

Prevalence of prescription opioid abuse has increased dramatically in recent years in the United States generally, and a similar pattern of increasing prescription opioid use has also been noted among patients seeking treatment for opioid dependence. The current study presents results from an internal quality-assurance project conducted by an outpatient methadone-maintenance (MM) treatment clinic which sought to examine the extent of ongoing oxycodone abuse among patients that might be going undetected with current urinalysis testing methods. One-hundred and five MM patients provided 437 urine samples over a 6-week period. Samples were analyzed using the clinic's usual enzyme multiplied immunoassay test (EMIT) opiate assay (300 ng/ml opiate cutpoint) and a supplemental oxycodone test strip (100 ng/ml oxycodone cutpoint). The EMIT assay identified only 6% (20/437) of samples as positive for oxycodone, while the oxycodone test strip indicated that 19% (83/437) tested positive for recent oxycodone use. Inspection of patient characteristics revealed that oxycodone users were more likely to report a prescription opioid as their primary drug at intake, be in MM treatment for a significantly shorter duration and provide significantly more opioid-and cocainepositive urine samples. Overall, these data illustrate the potential importance of monitoring for ongoing oxycodone use in MM clinics. While future efforts should examine this question using more rigorous experimental methods, findings from this initial project have implications for clinical issues such as evaluating patient stability in treatment, making medication dosing decisions, and determining patient eligibility for methadone take-home privileges.

Characteristics of Methadone Maintenance Treatment Patients Prescribed Opioid Analgesics

“…This is true for the general population and for those receiving methadone maintenance treatment (MMT). Among patients newly entering MMT programs, 67% and 82% used opioid analgesics within the previous month and year, respectively 2,3 , and up to 52% sought treatment primarily for opioid analgesics use disorders 2–4 . Most research examining opioid analgesic use in MMT patients focuses on opioid analgesics misuse or disorders.…”

Non Hodgkin's lymphoma presenting with bone pain and no lymphadenopathy

“…1 This may explain our patient's delay in presenting to secondary care and initial label as musculoskeletal chest pain in association with pneumonia despite the longer history of disabling symptoms. Clinicians should be aware that this, often difficult, group of patients to manage can have significant underlying diagnosis and opiate seeking behaviour should be a diagnosis by exclusion.…”

Advanced Urine Toxicology Testing

“…22 In an review of 8 commercially available opiate EIAs, the rates of detection of codeine, morphine, and semi-synthetic opiates were as follows: morphine (100%), codeine (100%), oxymorphone (≤ 15%), meperidine (≤ 3%), hydromorphone (≤ 60%), levorphanol (≤ 29%), and oxycodone (≤ 12%). This demonstrates that the standard opiate EIA is not designed to and will not detect 100% of semisynthetic opiates, including oxycodone.…”

“…24 The side-chains alter the morphine structure to the extent that the morphine antibody of the opiate EIA is unable to reliably bind to or "react" with oxycodone, resulting in frequent negative opiate EIAs. 6,8,22,25 Patients taking oxycodone submitting the expected negative opiate EIA urine in approximately 90% of specimens may, because of physician unawareness, stand accused of medication diversion and undergo sanctions, denial of medication, or clinic discharge. In one report, the authors state:…”