![]() Despite the decline in volume during this period, the overall demographic proportions of patients receiving drug testing remained similar ( 3), suggesting that substantial shifts in the patient demographics were not driving the increase. During 2020, positive test result rates were highest during March 29–April 11 (weeks 13–14) when the percentage of positive test results peaked at 40.5%. In the first 2 full weeks of January 2019, before the beginning of the COVID-19 pandemic, 9.6% of specimens from patients receiving MOUD tested positive for nonprescribed fentanyl the percentage testing positive approximately doubled by the end of 2019 (weeks 51–52) to 26.7% (Figure). During September–December 2020 (weeks 35–52), the numbers of specimens tested among patients receiving and not receiving MOUD were 43% and 13% lower, respectively, compared with the same period in 2019. The numbers of specimens tested among patients receiving and not receiving MOUD declined 65% and 72%, respectively, during March 29–Ap(weeks 14–15), compared with the same weeks in 2019. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.** SAS Studio (version 3.6 SAS Institute) was used to conduct all analyses. ¶ Among the 373,946 included specimens, 57,749 (15.4%) were from patients receiving MOUD. Among 427,915 specimens, 53,969 (12.6%) from patients whose opioid use disorder medication status was inconclusive were excluded from the analyses. † 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. A positive test result for nonprescribed fentanyl was defined as detection of norfentanyl (major fentanyl metabolite) or fentanyl not listed as prescribed. ![]() states and the District of Columbia were tested for fentanyl by using definitive mass spectrometry at Quest Diagnostics during 2019–2020. 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. Early in the pandemic, urine drug testing results indicated increases in nonprescribed fentanyl use ( 3, 4). Overdose deaths involving synthetic opioids excluding methadone (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).
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