Rate of Nonprescribed Fentanyl in Positive Urine Drug Screens Increasing

Positivity rates for nonprescribed fentanyl in cocaine- and methamphetamine-positive urine samples increased significantly between 2013 and 2018.

The prevalence of positive results for illicit fentanyl in urine drug screens also positive for cocaine or methamphetamine has significantly increased, according to study results published in JAMA Network Open.

Researchers conducted a cross-sectional analysis of 1 million urine drug test results from 2013 to 2018 that were included in a national drug testing database in the United States. The median age of the population was 44 (19-69) years, and 55.0% were women. Patient samples were collected from various clinical settings, including primary care and multispecialty practice groups. Each sample was tested for the presence of methamphetamine, cocaine, or fentanyl, and positivity rates of nonprescribed fentanyl among tests found positive for methamphetamine or cocaine were analyzed.

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After analysis, the researchers found that positivity rates for illicit fentanyl among the cocaine- and methamphetamine-positive tests had significantly risen from 2013 to 2018 (0.9% to 17.6%; P <.001 and 0.9% to 7.9%; P <.001, respectively). These data represent an 1850% increase for methamphetamine-positive and an 798% increase for cocaine-positive urine drug screens.

One key limitation of the study was the inclusion of partial or incorrect medication lists for prescription fentanyl use.

“Data from urine drug test results suggest this increase may be related to the simultaneous presence of fentanyl, either added directly to the drug supply or used concomitantly,” the researchers wrote.

“Efforts should be made to educate the public about this risk and about overdose prevention,” they concluded.

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LaRue L, Twillman RK, Dawson E, et al. Rate of fentanyl positivity among urine drug test results positive for cocaine or methamphetamine. JAMA Netw Open. 2019;2(4):e192851

This article originally appeared on Psychiatry Advisor