Impact of urine drug screening on opioid agonist treatment maintenance with buprenorphine in primary care in France: A cluster-randomized trial.

IF 1.8 4区医学 Q3 PHARMACOLOGY & PHARMACY

Therapie Pub Date : 2025-07-25 DOI:10.1016/j.therap.2025.07.003

Julie Dupouy, Vanessa Rousseau, Nicolas Authier, Paolo Di Patrizio, Gaetan Gentile, Valérie Gibaja, Catherine Laporte, Laurent Letrilliart, Christine Maynié, Joëlle Micallef, Michel Mallaret, Stéphane Oustric, Emilie Bérard, Maryse Lapeyre-Mestre

{"title":"Impact of urine drug screening on opioid agonist treatment maintenance with buprenorphine in primary care in France: A cluster-randomized trial.","authors":"Julie Dupouy, Vanessa Rousseau, Nicolas Authier, Paolo Di Patrizio, Gaetan Gentile, Valérie Gibaja, Catherine Laporte, Laurent Letrilliart, Christine Maynié, Joëlle Micallef, Michel Mallaret, Stéphane Oustric, Emilie Bérard, Maryse Lapeyre-Mestre","doi":"10.1016/j.therap.2025.07.003","DOIUrl":null,"url":null,"abstract":"Introduction: To assess the impact of onsite urine drug screening tests (OS-UDTs) in general practice compared with that of routine medical care on opioid agonist treatment (OAT) retention at six months in opioid-dependent patients initiating buprenorphine.Methods: In this cluster-randomized controlled trial, general practitioners (GPs) working in primary care and regularly managing patients treated with buprenorphine were invited to participate and were randomly assigned to the intervention or routine care group. GPs (cluster level) were asked to include 1-10 patients starting buprenorphine (individual level). The intervention included: (1) a training session on OS-UDTs; (2) the supply of OS-UDTs at GPs' offices; and (3) performing an OS-UDT before the first prescription of buprenorphine. The primary outcome was OAT retention at 6 months.Results: Among the 97 GPs included (intervention group: 49; control group: 48), 17 GPs included at least one patient, totaling 39 patients: 23 in the intervention group and 16 in the control group. Retention at 6 months was similar: 8 patients (34.7%) in the intervention group and 7 (43.8%) in the control group (OR=0.69 [95% CI: 0.18-2.56], P value=0.57). The patients were mainly men (69.2%), aged 39.3±11.6 years. All 13 patients in the intervention group who returned the acceptability questionnaire rated as \"normal medical practice\" the GP asking for OS-UDT for the management of OAT.Conclusion: In the context of a recent decline in the number of patients receiving OAT, and while all participating GPs reported regularly caring for patients for OUD, this inconclusive trial faced recruitment difficulties due to the low level of buprenorphine initiation in current daily practice. Nevertheless, this trial determined the characteristics of patients starting buprenorphine in primary care and revealed that OS-UDT was acceptable.Trial registration: NCT02345655.","PeriodicalId":23147,"journal":{"name":"Therapie","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapie","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.therap.2025.07.003","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: To assess the impact of onsite urine drug screening tests (OS-UDTs) in general practice compared with that of routine medical care on opioid agonist treatment (OAT) retention at six months in opioid-dependent patients initiating buprenorphine.

Methods: In this cluster-randomized controlled trial, general practitioners (GPs) working in primary care and regularly managing patients treated with buprenorphine were invited to participate and were randomly assigned to the intervention or routine care group. GPs (cluster level) were asked to include 1-10 patients starting buprenorphine (individual level). The intervention included: (1) a training session on OS-UDTs; (2) the supply of OS-UDTs at GPs' offices; and (3) performing an OS-UDT before the first prescription of buprenorphine. The primary outcome was OAT retention at 6 months.

Results: Among the 97 GPs included (intervention group: 49; control group: 48), 17 GPs included at least one patient, totaling 39 patients: 23 in the intervention group and 16 in the control group. Retention at 6 months was similar: 8 patients (34.7%) in the intervention group and 7 (43.8%) in the control group (OR=0.69 [95% CI: 0.18-2.56], P value=0.57). The patients were mainly men (69.2%), aged 39.3±11.6 years. All 13 patients in the intervention group who returned the acceptability questionnaire rated as "normal medical practice" the GP asking for OS-UDT for the management of OAT.

Conclusion: In the context of a recent decline in the number of patients receiving OAT, and while all participating GPs reported regularly caring for patients for OUD, this inconclusive trial faced recruitment difficulties due to the low level of buprenorphine initiation in current daily practice. Nevertheless, this trial determined the characteristics of patients starting buprenorphine in primary care and revealed that OS-UDT was acceptable.

Trial registration: NCT02345655.

查看原文本刊更多论文

尿药物筛选对阿片受体激动剂丁丙诺啡在法国初级保健维持治疗的影响：一项集群随机试验。

前言：评估现场尿液药物筛选试验（OS-UDTs）在普通实践中的影响，与常规医疗护理相比，对阿片类药物依赖患者开始丁丙诺啡后6个月阿片类药物激动剂治疗（OAT）的保留。方法：在本群随机对照试验中，邀请从事初级保健工作并定期管理丁丙诺啡治疗患者的全科医生（gp）参与，并随机分配到干预组或常规护理组。全科医生（集群水平）被要求纳入1-10例开始使用丁丙诺啡（个体水平）的患者。干预措施包括：(1)关于os - udt的培训；(2)在全科医生的办事处提供系统- udt；(3)首次开丁丙诺啡前进行OS-UDT。主要观察指标为6个月时OAT保留率。结果：纳入的97名全科医生（干预组49名，对照组48名）中，17名全科医生至少有1例患者，共计39例，干预组23例，对照组16例。6个月时，干预组8例（34.7%），对照组7例（43.8%）（OR=0.69 [95% CI: 0.18-2.56]， P值=0.57）。患者以男性为主（69.2%），年龄39.3±11.6岁。干预组13例患者均返回可接受性问卷，全科医生要求OS-UDT治疗OAT，均被评为“正常医疗实践”。结论：在最近接受OAT的患者数量下降的背景下，虽然所有参与的全科医生都报告定期照顾OUD患者，但由于目前日常实践中丁丙诺啡的起始水平较低，这项不确定的试验面临招募困难。尽管如此，该试验确定了在初级保健中开始使用丁丙诺啡的患者的特征，并显示OS-UDT是可以接受的。试验注册：NCT02345655。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Therapie 医学-药学

CiteScore

3.50

自引率

7.70%

发文量

132

审稿时长

57 days

期刊介绍： Thérapie is a peer-reviewed journal devoted to Clinical Pharmacology, Therapeutics, Pharmacokinetics, Pharmacovigilance, Addictovigilance, Social Pharmacology, Pharmacoepidemiology, Pharmacoeconomics and Evidence-Based-Medicine. Thérapie publishes in French or in English original articles, general reviews, letters to the editor reporting original findings, correspondence relating to articles or letters published in the Journal, short articles, editorials on up-to-date topics, Pharmacovigilance or Addictovigilance reports that follow the French "guidelines" concerning good practice in pharmacovigilance publications. The journal also publishes thematic issues on topical subject. The journal is indexed in the main international data bases and notably in: Biosis Previews/Biological Abstracts, Embase/Excerpta Medica, Medline/Index Medicus, Science Citation Index.