Urine drug testing survey and characteristics of populations of seven Los Angeles County methadone maintenance clinics

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ABSTRACT
Introduction
Method
Results and discussion

Details

Author: R. D. BUDD
Pages: 27 to 30
Creation Date: 1980/01/01

Urine drug testing survey and characteristics of populations of seven Los Angeles County methadone maintenance clinics

R. D. BUDD
Rancho Los Amigos Hospital, Downey, California, United States of America

ABSTRACT

One thousand urine samples from each of the seven Los Angeles County methadone maintenance clinics were examined for presence of drugs of abuse. The clinic populations were also concurrently studied with regard to various social factors. Significant variations which have been found among the clinics in both population characteristics and drugs detected in urine samples are discussed in the paper.

Introduction

A retrospective survey of drug-use patterns among the methadone maintenance population of Los Angeles County was undertaken in an effort to provide some information on the effectiveness of methadone maintenance programmes in rehabilitating heroin addicts. Over 5,000urine samples from 730patients were analysed for 11 drugs over a two-month period in 1975 and the results of this analysis were discussed in the Bulletin on Narcotics [ 1] .

This research was continued in 1976. A urine drug testing survey of patients in the seven clinics of the Los Angeles County methadone maintenance programmes was undertaken as well as a retrospective study of selected characteristics of patients involved in these programmes.

The seven clinics are located in different areas of the county and consequently receive patients from different ethnic populations [ 2] [ 3] [ 4] [ 5] . As a follow-up to this survey it has been sought to evaluate urine drug testing data by the results of clinic assessment.

Method

One thousand urine samples from each of the seven Los Angeles County methadone maintenance clinics, collected from March to July 1976, were analysed for the presence of morphine, codeine, amphetamine, methamphetamine, aUylbarbital, amobarbital, butabarbital, pentobarbital, phenobarbital, secobarbital, methadone, and, when necessary, primary methadone metabolite (2-ethylidene-1, 5-dimethyl-3, 3-diphenylpyrrolidine). The population characteristics, such as ethnicity, employment status, age, criminal record and length of time in the programme of the clinics during the same period are shown in table 1. This information was obtained from the central offices [ 2] [ 3] [ 4] [ 5] . The results of urine testing by clinics is shown in table 2.

Table 1

Population characteristics by clinic

 

Clinic No.

 

Characteristics

1

2

3

4

5

6

7

Average

Population size
76 79 124 158 80 89 100 101
Average age (years)
40.8 37.5 36.6 36.5 34.7 32.7 41.9 37.2
Average time in programme (months)
22.7 18.0 19.3 23.4 13.3 11.5 25.9 19.2
Other studied variables
Percentage
Male
73.2 60.5 60.2 78.6 77.6 84.6 72.3 72.4
White
25.2 59.5 55.1 53.4 46.0 42.1 17.1 42.6
Black
1.2 11.3 15.1 2.1 5.5 3.9 49.0 12.6
Mexican-American
73.6 29.2 28.2 42.1 48.5 53.9 31.8 43.9
Other races
-
-
1.6 2.4
-
-
2.1 0.9
Employed or in job training
60.3 64.2 61.4 70.7 56.8 58.6 56.5 61.2
Unemployed
28.2 24.8 14.6 12.1 28.5 31.1 11.0 21.5
House parent
9.9 3.1 11.4 11.4 8.6 10.3 11.0 9.4
Disabled
1.6 7.9 12.6 5.8 6.1
-
21.6 7.9
On probation
19.7 10.3 25.0 11.7 15.0 12.9 19.5 16.3
On parole
9.0 6.9 9.6 18.6 20.5 35.0 12.0 16.0
On probation and parole
0.4
-
0.8 1.4
-
2.5 0.7 0.8
Neither on parole nor on probation
70.9 82.8 64.6 68.3 64.5 49.6 67.8 66.9
No take-home privileges
40.1 37.8 15.2 25.9 54.4 55.9 30.1 37.1

Results and discussion

There are a number of notable differences between the clinics. One of the most obvious is racial distribution. Clinic I had the greatest percentage of Mexican Americans and the lowest percentage of blacks. Clinic 2 had the greatest percentage of whites and the highest percentage of persons who were neither on parole nor on probation. Clinic 4 had the highest percentage of persons employed or in job-training programmes. Clinic 7 had the highest average time in the programme, the lowest percentage of whites, the highest percentage of blacks and the lowest percentage of persons employed or in job-training programmes.

A breakdown of drug results for 1,000 samples from each clinic is shown in tables 2 and 3. Nearly 99 per cent of the samples tested were positive for methadone or methadone metabolite or both. The positive rate for drugs other than methadone for the entire 7,000 specimens was 25.5 per cent and ranged from 17.2 to 40.4 per cent for the individual clinics. Opiates made up 73.7 per cent of the drugs found (ranging from 57 to 83.6 per cent); barbiturates made up 20.5 per cent (ranging from 10.3 to 38.6 per cent); and amphetamine and methamphetamine made up 5.8 per cent (ranging from 3.7 per cent to 9.3 per cent). Morphine was the most commonly found drug in all clinics, followed by codeine and phenobarbital. Together, these three drugs made up 88.2 per cent of all the drugs found.

Table 2

Results of urine drug testing by clinic

(Based on 1,000 samples per clinic)

 

Clinic No.

 

Characteristics

1

2

3

4

5

6

7

Total

Average

Methadone or methadone metabolite
966 1 000 992 986 979 994 986 6 903 986.2
Negative for methadone and methadone metabolite
34 0 8 14 21 6 14 97 13.8
Allylbarbital
2 7 2 0 4 2 6 23 3.3
Butabarbital
0 0 1 0 0 2 6 9 1.3
Amobarbital
3 3 2 5 8 3 11 35 5.0
Pentobarbital
3 0 13 1 6 5 1 29 4.1
Secobarbital
6 4 12 4 3 12 5 46 6.6
Phenobarbital
56 14 66 42 26 68 67 339 48.4
Codeine
96 64 53 26 75 68 223 605 86.4
Morphine
177 160 89 113 209 233 324 1 305 186.4
Amphetamine
17 10 10 7 28 25 23 120 17.1
Methamphetamine
4 6 1 1 6 8 2 28 4.0
Negative
753 808 813 828 725 693 596 5216 745.1
Positive
247 192 187 172 275 307 404 1784 254.9
Total drugs
364 268 249 199 365 426 668 2539 362.7
Drugs per positive sample
1.47 1.40 1.33 1.16 1.33 1.39 1.65 1.42 1.39

Table 3

Positive results by substance and clinic

(Percentage distribution)

 

Clinic No.

 

Substance

1

2

3

4

5

6

7

Average

Short-acting barbiturates
3.8 5.2 12.1 5.0 5.8 5.6 4.3 6.0
Phenobarbital (long-acting)
15.4 5.2 26.5 21.1 7.1 15.0 10.0 14.5
Codeine
26.4 23.9 21.3 13.1 20.5 16.0 33.4 22.1
Morphine
48.6 59.7 35.7 56.8 57.3 54.7 48.5 51.6
Stimulant-amines
5.8 6.0 4.4 4.0 9.3 7.7 3.7 5.8

Clinic 7 was found to have the highest rate of positive drug results, the most drugs, the highest ratio of drugs per positive specimen, the highest use of opiates, and the highest use of barbiturates. Clinic 5 was found to have the highest use of amphetamine. Clinic 4 was found to have the lowest positive rate, the fewest drugs, the fewest amphetamines, the fewest opiates and the lowest ratio of drugs per positive sample.

As can be readily observed (and verified with a chi-squared distribution), there are significant differences among the seven clinics with regards to both urine drug results and population characteristics such as race, employment status and legal status.

The amount of drug use appears to be proportional to the quality of management and the quality of staff services at the individual clinics; the better the programme, the lower the amount of illicit drug use by the patients [ 6] . For example, clinic 4 has been able to keep a large percentage of its population employed and has had concurrently, for a long time, a lower level of illicit drug use.

Other factors such as culture and environment would also be expected to affect the amount and type of illicit drug use in a clinic area. These factors cannot be completely overcome by the programme staff.

Data were not available during this study for a correlation to be made with drug abuse and population characteristics on an individual person basis.

References

001

N. C. Jain and others, "Patterns of drug abuse among methadone maintenance patients in Los Angeles County", Bulletin on Narcotics (United Nations publication), vol. 29, No. 2 (1977), pp. 45-52.

002

R. Topalian, Monthly Methadone Data Report Management Information System (County of Los Angeles, Department of Health Services, March 1976).

003

R. Topalian, Monthly Methadone Data Report Management Information System (County of Los Angeles, Department of Health Services, April 1976).

004

R. Topalian, Monthly Methadone Data Report Management Information System (County of Los Angeles, Department of Health Services, May 1976).

005

R. Topalian, Monthly Methadone Data Report Management Information System (County of Los Angeles, Department of Health Services, June 1976).

006

P. G. Bourne, Methadone, Benefits and Shortcomings (Washington, DC, Drug Abuse Council, 1975).