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    Research Letter
    Public Health
    January 3, 2020

    Evaluation of Trends of Near-Real-Time Urine Drug Test Results for Methamphetamine, Cocaine, Heroin, and Fentanyl

    Author Affiliations
    • 1Saint Luke’s Health System, Kansas City, Missouri
    • 2Volunteer Faculty, Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City
    • 3Millennium Health, San Diego, California
    JAMA Netw Open. 2020;3(1):e1918514. doi:10.1001/jamanetworkopen.2019.18514

    The US Centers for Disease Control and Prevention recently projected that the number of drug overdose deaths would total approximately 68 000 in 2018, down from 71 000 deaths in 2017.1 This represents the first reported decline since 1990 and is largely attributed to a decrease in deaths involving prescription opioids. However, deaths associated with synthetic opioids, primarily fentanyl, as well as stimulants appear to be increasing.1 In 2019,2 we reported a 798% increase in urine drug test (UDT) positivity rates for nonprescribed fentanyl among results positive for methamphetamine and an 1850% increase among results positive for cocaine. In an effort to conduct ongoing surveillance of the polysubstance use landscape and help characterize these evolving trends in a more timely manner, we examined our UDT data as close to real-time as possible to observe trends in positivity for methamphetamine, cocaine, and heroin, with and without illicit fentanyl. We hypothesize that UDT data are closely aligned with the Centers for Disease Control and Prevention’s overdose death data and the US Drug Enforcement Administration’s drug confiscations data and may have the potential to more quickly inform public health safety officials of possible shifts in these trends.3