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Published in: BMC Primary Care 1/2016

Open Access 01-12-2016 | Study protocol

Study protocol of the ESUB-MG cluster randomized trial: a pragmatic trial assessing the implementation of urine drug screening in general practice for buprenorphine maintained patients

Author: The ESUB-MG Study Group

Published in: BMC Primary Care | Issue 1/2016

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Abstract

Background

In addiction care, urine drug screening tests are recommended to assess psychoactive substances use. While intrinsic diagnostic value of these tests is demonstrated, the consequences of carrying out these tests on opiate maintenance treatment (OMT) have not been established. The main objective will be to assess the impact of on-site urine drug screening tests (OS-UDS) in general practice compared to routine medical care on OMT retention at 6 months in opioid-dependent patients initiating buprenorphine.

Methods/Design

The ESUB-MG study uses a pragmatic, cluster randomized controlled trial design. General Practitioners (GPs) regularly managing patients treated with buprenorphine and consenting for participating will be invited to participate. GPs will be randomly assigned to one of two groups for 6 to 24 months: (a) control group (usual care: standard medical strategy for assessing drug use); (b) interventional group (including 1/ a training session on practice and interpretation of OS-UDS; 2/ the supply of OS-UDS at GPs’ medical offices; 3/ performing an OS-UDS before the first prescription of buprénorphine). GPs will have to include 1 to 10 patients aged 18 years-old or more, consulting for starting treatment by buprenorphine, not opposed to participate. The primary outcome will be OMT retention at 6 months.

Discussion

This randomized interventional trial should bring sufficient level of evidence to assess effectiveness of performing OS-UDS in general practice for patients treated by buprenorphine. Training GPs to drug tests and supplying them in their office should lead to an improvement of opioid-addicted patients’ care through helping decision.

Trials registration

NCT02345655 (first registration May 14, 2014)
Literature
1.
2.
go back to reference Nyswander M, Dole VP. The present status of methadone blockade treatment. Am J Psychiatry. 1967;123:1441–2.CrossRefPubMed Nyswander M, Dole VP. The present status of methadone blockade treatment. Am J Psychiatry. 1967;123:1441–2.CrossRefPubMed
4.
go back to reference Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat. 2005;28:321–9.CrossRefPubMed Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat. 2005;28:321–9.CrossRefPubMed
5.
go back to reference Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2008;3:CD002207. Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2008;3:CD002207.
6.
go back to reference Bruce RD, Govindasamy S, Sylla L, Kamarulzaman A, Altice FL. Lack of Reduction in Buprenorphine Injection After Introduction of Co-Formulated Buprenorphine/Naloxone to the Malaysian Market. Am J Drug Alcohol Abuse. 2009;35:68–72.CrossRefPubMedPubMedCentral Bruce RD, Govindasamy S, Sylla L, Kamarulzaman A, Altice FL. Lack of Reduction in Buprenorphine Injection After Introduction of Co-Formulated Buprenorphine/Naloxone to the Malaysian Market. Am J Drug Alcohol Abuse. 2009;35:68–72.CrossRefPubMedPubMedCentral
7.
go back to reference Simojoki K, Vorma H, Alho H. A retrospective evaluation of patients switched from buprenorphine (subutex) to the buprenorphine/naloxone combination (suboxone). Subst Abuse Treat Prev Policy. 2008;3:16.CrossRefPubMedPubMedCentral Simojoki K, Vorma H, Alho H. A retrospective evaluation of patients switched from buprenorphine (subutex) to the buprenorphine/naloxone combination (suboxone). Subst Abuse Treat Prev Policy. 2008;3:16.CrossRefPubMedPubMedCentral
9.
go back to reference Fatseas M, Auriacombe M. Why buprenorphine is so successful in treating opiate addiction in France. Curr Psychiatry Rep. 2007;9:358–64.CrossRefPubMed Fatseas M, Auriacombe M. Why buprenorphine is so successful in treating opiate addiction in France. Curr Psychiatry Rep. 2007;9:358–64.CrossRefPubMed
10.
go back to reference Auriacombe M, Fatséas M, Dubernet J, Daulouède J-P, Tignol J. French field experience with buprenorphine. Am J Addict. 2004;13 Suppl 1:S17–28.CrossRefPubMed Auriacombe M, Fatséas M, Dubernet J, Daulouède J-P, Tignol J. French field experience with buprenorphine. Am J Addict. 2004;13 Suppl 1:S17–28.CrossRefPubMed
11.
go back to reference Dupouy J, Bismuth S, Oustric S, Lapeyre-Mestre M. On-Site Drugs of Abuse Urinary Screening Tests for the Management of Opiate-Addicted Patients: A Survey among French General Practitioners. Eur Addict Res. 2012;18:175–83.CrossRefPubMed Dupouy J, Bismuth S, Oustric S, Lapeyre-Mestre M. On-Site Drugs of Abuse Urinary Screening Tests for the Management of Opiate-Addicted Patients: A Survey among French General Practitioners. Eur Addict Res. 2012;18:175–83.CrossRefPubMed
12.
go back to reference Lavie E, Fatséas M, Daulouède J-P, Denis C, Dubernet J, Cattan L, et al. Comparison of prescriber evaluations and patient-directed self-reports in office-based practice for buprenorphine treatment of opiate-dependent individuals in France, 2002. Patient Prefer Adherence. 2008;2:369–78.PubMedPubMedCentral Lavie E, Fatséas M, Daulouède J-P, Denis C, Dubernet J, Cattan L, et al. Comparison of prescriber evaluations and patient-directed self-reports in office-based practice for buprenorphine treatment of opiate-dependent individuals in France, 2002. Patient Prefer Adherence. 2008;2:369–78.PubMedPubMedCentral
13.
go back to reference Lapeyre-Mestre M, Llau M-E, Gony M, Navel A-M, Bez J, Grau M, et al. Opiate maintenance with buprenorphine in ambulatory care: a 24-week follow-up study of new users. Drug Alcohol Depend. 2003;72:297–303.CrossRefPubMed Lapeyre-Mestre M, Llau M-E, Gony M, Navel A-M, Bez J, Grau M, et al. Opiate maintenance with buprenorphine in ambulatory care: a 24-week follow-up study of new users. Drug Alcohol Depend. 2003;72:297–303.CrossRefPubMed
14.
go back to reference Galletly CA, Field CD, Prior M. Urine drug screening of patients admitted to a state psychiatric hospital. Hosp Community Psychiatry. 1993;44:587–9.PubMed Galletly CA, Field CD, Prior M. Urine drug screening of patients admitted to a state psychiatric hospital. Hosp Community Psychiatry. 1993;44:587–9.PubMed
15.
go back to reference Kilpatrick B, Howlett M, Sedgwick P, Ghodse AH. Drug use, self report and urinalysis. Drug Alcohol Depend. 2000;58:111–6.CrossRefPubMed Kilpatrick B, Howlett M, Sedgwick P, Ghodse AH. Drug use, self report and urinalysis. Drug Alcohol Depend. 2000;58:111–6.CrossRefPubMed
16.
go back to reference Lundy A, Gottheil E, McLellan AT, Weinstein SP, Sterling RC, Serota RD. Underreporting of cocaine use at posttreatment follow-up and the measurement of treatment effectiveness. J Nerv Ment Dis. 1997;185:459–62.CrossRefPubMed Lundy A, Gottheil E, McLellan AT, Weinstein SP, Sterling RC, Serota RD. Underreporting of cocaine use at posttreatment follow-up and the measurement of treatment effectiveness. J Nerv Ment Dis. 1997;185:459–62.CrossRefPubMed
17.
go back to reference Olshaker JS, Browne B, Jerrard DA, Prendergast H, Stair TO. Medical clearance and screening of psychiatric patients in the emergency department. Acad Emerg Med. 1997;4:124–8.CrossRefPubMed Olshaker JS, Browne B, Jerrard DA, Prendergast H, Stair TO. Medical clearance and screening of psychiatric patients in the emergency department. Acad Emerg Med. 1997;4:124–8.CrossRefPubMed
18.
go back to reference Perrone J, De Roos F, Jayaraman S, Hollander JE. Drug screening versus history in detection of substance use in ED psychiatric patients. Am J Emerg Med. 2001;19:49–51.CrossRefPubMed Perrone J, De Roos F, Jayaraman S, Hollander JE. Drug screening versus history in detection of substance use in ED psychiatric patients. Am J Emerg Med. 2001;19:49–51.CrossRefPubMed
19.
go back to reference Mordal J, Holm B, Mørland J, Bramness JG. Recent substance intake among patients admitted to acute psychiatric wards: physician’s assessment and on-site urine testing compared with comprehensive laboratory analyses. J Clin Psychopharmacol. 2010;30:455–9.CrossRefPubMed Mordal J, Holm B, Mørland J, Bramness JG. Recent substance intake among patients admitted to acute psychiatric wards: physician’s assessment and on-site urine testing compared with comprehensive laboratory analyses. J Clin Psychopharmacol. 2010;30:455–9.CrossRefPubMed
20.
go back to reference Zullino DF, Krenz S, Eap CB, Benguettat D, Khan R. Over- and underreporting of recent drug use in subjects entering an inpatient detoxification unit. Eur J Med Res. 2008;13:15–20.PubMed Zullino DF, Krenz S, Eap CB, Benguettat D, Khan R. Over- and underreporting of recent drug use in subjects entering an inpatient detoxification unit. Eur J Med Res. 2008;13:15–20.PubMed
23.
go back to reference Pesce A, Rosenthal M, West R, West C, Crews B, Mikel C, et al. An evaluation of the diagnostic accuracy of liquid chromatography-tandem mass spectrometry versus immunoassay drug testing in pain patients. Pain Physician. 2010;13:273–81.PubMed Pesce A, Rosenthal M, West R, West C, Crews B, Mikel C, et al. An evaluation of the diagnostic accuracy of liquid chromatography-tandem mass spectrometry versus immunoassay drug testing in pain patients. Pain Physician. 2010;13:273–81.PubMed
24.
go back to reference Bagøien G, Morken G, Zahlsen K, Aamo T, Spigset O. Evaluation of a urine on-site drugs of abuse screening test in patients admitted to a psychiatric emergency unit. J Clin Psychopharmacol. 2009;29:248–54.CrossRefPubMed Bagøien G, Morken G, Zahlsen K, Aamo T, Spigset O. Evaluation of a urine on-site drugs of abuse screening test in patients admitted to a psychiatric emergency unit. J Clin Psychopharmacol. 2009;29:248–54.CrossRefPubMed
25.
go back to reference Manchikanti L, Manchukonda R, Pampati V, Damron KS, Brandon DE, Cash KA, et al. Does random urine drug testing reduce illicit drug use in chronic pain patients receiving opioids? Pain Physician. 2006;9:123–9.PubMed Manchikanti L, Manchukonda R, Pampati V, Damron KS, Brandon DE, Cash KA, et al. Does random urine drug testing reduce illicit drug use in chronic pain patients receiving opioids? Pain Physician. 2006;9:123–9.PubMed
26.
go back to reference Manchikanti L, Malla Y, Wargo BW, Fellows B. Comparative evaluation of the accuracy of benzodiazepine testing in chronic pain patients utilizing immunoassay with liquid chromatography tandem mass spectrometry (LC/MS/MS) of urine drug testing. Pain Physician. 2011;14:259–70.PubMed Manchikanti L, Malla Y, Wargo BW, Fellows B. Comparative evaluation of the accuracy of benzodiazepine testing in chronic pain patients utilizing immunoassay with liquid chromatography tandem mass spectrometry (LC/MS/MS) of urine drug testing. Pain Physician. 2011;14:259–70.PubMed
27.
go back to reference Dupouy J, Dassieu L, Bourrel R, Poutrain J-C, Bismuth S, Oustric S, et al. Effectiveness of drug tests in outpatients starting opioid substitution therapy. J Subst Abuse Treat. 2013;44:515–21.CrossRefPubMed Dupouy J, Dassieu L, Bourrel R, Poutrain J-C, Bismuth S, Oustric S, et al. Effectiveness of drug tests in outpatients starting opioid substitution therapy. J Subst Abuse Treat. 2013;44:515–21.CrossRefPubMed
28.
go back to reference McCowan C, Kidd B, Fahey T. Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study. BMJ. 2009;338:b2225.CrossRefPubMedPubMedCentral McCowan C, Kidd B, Fahey T. Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study. BMJ. 2009;338:b2225.CrossRefPubMedPubMedCentral
29.
go back to reference Jouanjus E, Gibaja V, Kahn J-P, Haramburu F, Daveluy A. Signal identification in addictovigilance: the functioning of the French system. Therapie. 2015;70:113–31.CrossRefPubMed Jouanjus E, Gibaja V, Kahn J-P, Haramburu F, Daveluy A. Signal identification in addictovigilance: the functioning of the French system. Therapie. 2015;70:113–31.CrossRefPubMed
30.
go back to reference Baumevieille M, Daveluy A, Maurain C, Bégaud B, Haramburu F. Medicines submitted to narcotics regulations in France, 1992–2007. Fundam Clin Pharmacol. 2009;23:345–9.CrossRefPubMed Baumevieille M, Daveluy A, Maurain C, Bégaud B, Haramburu F. Medicines submitted to narcotics regulations in France, 1992–2007. Fundam Clin Pharmacol. 2009;23:345–9.CrossRefPubMed
33.
go back to reference Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide for clinicians. Mayo Clin Proc. 2008;83:66–76.CrossRefPubMed Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide for clinicians. Mayo Clin Proc. 2008;83:66–76.CrossRefPubMed
34.
go back to reference Nordmann S, Frauger E, Pauly V, Orléans V, Pradel V, Mallaret M, et al. Misuse of buprenorphine maintenance treatment since introduction of its generic forms: OPPIDUM survey. Pharmacoepidemiol Drug Saf. 2012;21:184–90.CrossRefPubMed Nordmann S, Frauger E, Pauly V, Orléans V, Pradel V, Mallaret M, et al. Misuse of buprenorphine maintenance treatment since introduction of its generic forms: OPPIDUM survey. Pharmacoepidemiol Drug Saf. 2012;21:184–90.CrossRefPubMed
35.
go back to reference Roux P, Lions C, Michel L, Cohen J, Mora M, Marcellin F, et al. Predictors of Non-Adherence to Methadone Maintenance Treatment in Opioid-Dependent Individuals: Implications for Clinicians. Curr Pharm Des. 2013;20:4097–105.CrossRef Roux P, Lions C, Michel L, Cohen J, Mora M, Marcellin F, et al. Predictors of Non-Adherence to Methadone Maintenance Treatment in Opioid-Dependent Individuals: Implications for Clinicians. Curr Pharm Des. 2013;20:4097–105.CrossRef
36.
go back to reference Leino A, Loo B-M. Comparison of three commercial tests for buprenorphine screening in urine. Ann Clin Biochem. 2007;44:563–5.CrossRefPubMed Leino A, Loo B-M. Comparison of three commercial tests for buprenorphine screening in urine. Ann Clin Biochem. 2007;44:563–5.CrossRefPubMed
37.
go back to reference Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ. 2010;341:c5475.CrossRefPubMedPubMedCentral Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ. 2010;341:c5475.CrossRefPubMedPubMedCentral
38.
go back to reference Schwarz R, Zelenev A, Bruce RD, Altice FL. Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence. J Subst Abuse Treat. 2012;43:451–7.CrossRefPubMedPubMedCentral Schwarz R, Zelenev A, Bruce RD, Altice FL. Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence. J Subst Abuse Treat. 2012;43:451–7.CrossRefPubMedPubMedCentral
39.
go back to reference Moulis G, Lapeyre-Mestre M, Palmaro A, Pugnet G, Montastruc J-L, Sailler L. French health insurance databases: What interest for medical research? Rev Med Interne. 2015;34:411–7.CrossRef Moulis G, Lapeyre-Mestre M, Palmaro A, Pugnet G, Montastruc J-L, Sailler L. French health insurance databases: What interest for medical research? Rev Med Interne. 2015;34:411–7.CrossRef
40.
go back to reference da Silveira DP, Artmann E. Accuracy of probabilistic record linkage applied to health databases: systematic review. Rev Saude Publica. 2009;43:875–82.CrossRefPubMed da Silveira DP, Artmann E. Accuracy of probabilistic record linkage applied to health databases: systematic review. Rev Saude Publica. 2009;43:875–82.CrossRefPubMed
41.
go back to reference Perlbarg J, Allonier C, Boisnault P, Daniel F, Le Fur P, Szidon P, et al. Feasibility and practical value of statistical matching of a general practice database and a health insurance database applied to diabetes and hypertension. Sante Publique. 2014;26:355–63.PubMed Perlbarg J, Allonier C, Boisnault P, Daniel F, Le Fur P, Szidon P, et al. Feasibility and practical value of statistical matching of a general practice database and a health insurance database applied to diabetes and hypertension. Sante Publique. 2014;26:355–63.PubMed
42.
go back to reference Wears RL. Advanced statistics: statistical methods for analyzing cluster and cluster-randomized data. Acad Emerg Med. 2002;9:330–41.CrossRefPubMed Wears RL. Advanced statistics: statistical methods for analyzing cluster and cluster-randomized data. Acad Emerg Med. 2002;9:330–41.CrossRefPubMed
43.
go back to reference van Breukelen GJP, Candel MJJM, Berger MPF. Relative efficiency of unequal versus equal cluster sizes in cluster randomized and multicentre trials. Stat Med. 2007;26:2589–603.CrossRefPubMed van Breukelen GJP, Candel MJJM, Berger MPF. Relative efficiency of unequal versus equal cluster sizes in cluster randomized and multicentre trials. Stat Med. 2007;26:2589–603.CrossRefPubMed
44.
go back to reference Laurence C, Gialamas A, Yelland L, Bubner T, Ryan P, Willson K, et al. A pragmatic cluster randomised controlled trial to evaluate the safety, clinical effectiveness, cost effectiveness and satisfaction with point of care testing in a general practice setting - rationale, design and baseline characteristics. Trials. 2008;9:50.CrossRefPubMedPubMedCentral Laurence C, Gialamas A, Yelland L, Bubner T, Ryan P, Willson K, et al. A pragmatic cluster randomised controlled trial to evaluate the safety, clinical effectiveness, cost effectiveness and satisfaction with point of care testing in a general practice setting - rationale, design and baseline characteristics. Trials. 2008;9:50.CrossRefPubMedPubMedCentral
45.
go back to reference Hayes RJ, Moulton LH. Cluster randomised trials. Chapman & Hall / CRC: CRC Press Taylor & Francis Group; 2009.CrossRef Hayes RJ, Moulton LH. Cluster randomised trials. Chapman & Hall / CRC: CRC Press Taylor & Francis Group; 2009.CrossRef
Metadata
Title
Study protocol of the ESUB-MG cluster randomized trial: a pragmatic trial assessing the implementation of urine drug screening in general practice for buprenorphine maintained patients
Author
The ESUB-MG Study Group
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2016
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-016-0413-3

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