Comparison of Tuberculin Skin Testing Reactivity in Opioid-Dependent Patients Seeking Treatment with Methadone versus Buprenorphine: Policy Implications for Tuberculosis Screening

• Published in: The American journal of drug and alcohol abuse 2009-12, Vol.35 (6), p.439-444
• Main Authors: Schwarz, Ryan K., Bruce, R. Douglas, Ball, Samuel A., Herme, Maua, Altice, Frederick L.
• Format: Article
• Language: English
• Subjects: Adult; Buprenorphine; Buprenorphine - therapeutic use; Comparative studies; Drug addiction; Drug dependency; Female; Health; Higher education; Hispanic Americans; Humans; Male; Medical research; Medical screening; methadone; Methadone - therapeutic use; Methadone Maintenance; mobile health care; Opioid-Related Disorders - complications; Opioid-Related Disorders - drug therapy; Patients; Policy Making; Positive affect; Prevalence; Primary care; Primary Health Care; Racial Differences; Racial discrimination; Screening; Skin; substance abuse; Tests; Tuberculin Test; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - epidemiology
• ISSN: 0095-2990; 1097-9891
• DOI: 10.3109/00952990903447741

Background: Buprenorphine's availability in primary care settings offers increased access to treatment and linkage to primary care for opioid-dependent patients. Currently, tuberculin skin testing (TST) is recommended for patients enrolling in methadone maintenance treatment (MMT), but not for those enrolling in buprenorphine maintenance treatment (BMT). Objectives: To compare TST screening results in enrollees in BMT and MMT programs and assess the correlates of TST positivity among these subjects. Methods: A cross-sectional analysis of a retrospective cohort study was conducted to compare concurrent TST results among contemporaneously matched groups of MMT and BMT patients in the same community. Results: TST positivity was ∼9% in both MMT and BMT settings (p = .27). Increased TST positivity was associated with being Black (AOR = 3.53, CI = 1.28-9.77), Hispanic (AOR = 3.11, CI = 1.12-8.60), and having higher education (AOR = 3.01, CI = 1.20-7.53). Conclusions: These results confirm a similar high prevalence of TST positivity in opioid-dependent patients enrolling in MMT and BMT programs. Racial and ethnic health disparities remain associated with TST positivity, yet a relationship between higher education and tuberculosis requires further investigation. Scientific significance: These data suggest the importance of incorporating TST screening in emerging BMT programs as a mechanism to provide increased detection and treatment of tuberculosis infection in opioid-dependent patient populations.