Notes from the Field: Testing for Nonprescribed Fentanyl and Percentage of Positive Test Results Among Patients with Opioid Use Disorder — United States, 2019–2020

Abstract

Overdose deaths involving synthetic opioids excluding meth-adone (primarily illicitly manufactured fentanyl) have increased approximately tenfold since 2013 (1) and have accelerated during the COVID-19 pandemic, with provisional estimates indicating that synthetic opioid-involved deaths increased 49.4% for the 12-month period ending April 2021.* During the pandemic, persons requiring medication for opioid use disorder (MOUD) might face additional challenges to accessing treatment (e.g., due to closure of providers' offices) (2). Early in the pandemic, urine drug testing results indicated increases in nonprescribed fentanyl use (3,4). To determine trends in testing for fentanyl and the percentage of positive test results before and during the pandemic, clinical drug monitoring of urine specimens from patients residing in all U.S. states and the District of Columbia were tested for fentanyl by using definitive mass spectrometry at Quest Diagnostics during 2019-2020. A positive test result for nonprescribed fentanyl was defined as detection of norfentanyl (major fentanyl metabolite) or fentanyl not listed as prescribed. † Patients receiving MOUD were identified as those having an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) F11 code (opioid-related disorders) § and a positive test result for buprenorphine or methadone listed as prescribed. Among 427,915 specimens, 53,969 (12.6%) from patients whose opioid use disorder medication status was inconclusive were excluded from the analyses. ¶ Among the 373,946 included specimens, 57,749 (15.4%) were from patients receiving MOUD. SAS Studio (version 3.6; SAS Institute) was used