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Changes in fentanyl positivity among MOUD patients

Non-prescribed fentanyl positivity among patients receiving medication for opioid use disorder (MOUD) spiked in the early days of the COVID-19 pandemic, but fell back to approximately pre-pandemic levels within several months, according to a study from Quest Diagnostic scientists. Meanwhile, fentanyl positivity among patients not receiving MOUD oscillated throughout the pandemic, but showed a trend of overall increase.

The research team tested 373,946 specimens for non-prescribed fentanyl, 15% of which were from MOUD patients. During the early weeks of the pandemic, in spring 2020, the number of tests performed nationwide declined dramatically compared to 2019 levels, and remained low throughout the year, especially for patients receiving MOUD.

Among MOUD patients, fentanyl positivity was found in 9.6% of specimens in early 2019, and climbed to 26.7% by the end of the year. In early spring 2020, the rate peaked at 40.5%, before dropping 24.3% by the beginning of May, and continuing to fall through the year, to a low of 11.9%. 

Among non-MOUD patients, fentanyl positivity was found in approximately 1.2-1.8% of patients throughout the testing periods, with a slight elevation over time during 2020.

The changes in positivity rates were unlikely to be due to changes in sampling volume, the authors noted, as the demographics of the tested population remained the same throughout.

“A decline in drug monitoring disproportionately affected patients receiving MOUD during March–May 2020 and continued through the end of 2020, raising concerns regarding potential treatment disruptions or patients forgoing monitoring tests during the pandemic,” the authors stated. “In the context of predicted increases in opioid-involved and synthetic opioid–involved overdoses throughout 2020, the continued lower test volume and lower percentage of positive test results for nonprescribed fentanyl during September–December 2020 among patients receiving MOUD should be investigated to ensure that patients at highest risk for health harms are receiving health care and are retained in care.”

Niles JK, Gudin J, Vivolo-Kantor AM, et al. Notes from the Field: Testing for Nonprescribed Fentanyl and Percentage of Positive Test Results Among Patients with Opioid Use Disorder - United States, 2019-2020. MMWR Morb Mortal Wkly Rep. 2021 Nov 26;70(47):1649-1651.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8612509/