The Patient Scenario
An opioid-dependent patient with chronic pain has begun to use prescription opioids, problematically. In consultation with his current prescriber who has the appropriate waiver from the Center for Substance Abuse Treatment (CSAT) to prescribe buprenorphine for addiction, the decision is made to abandon the traditional opioid analgesics in favor of maintenance with sublingual buprenorphine. During his follow-up appointment at one month, the physician orders a UDT to assess treatment adherence. A urine test done by GC/MS is ordered.
Urine drug test done by GC/MS
The Test Results
The results are negative for opioids including buprenorphine.
The Test Interpretation
The fact that a certain prescription drug is not routinely detected can be used to clinical advantage when assessing treatment compliance. For example, a negative GC/MS panel for opioids, in the context of clinical stability, is reassuring even in the apparent absence of buprenorphine. The latter being a reflection of testing limits, not the true absence of a prescribed drug.
The Final Outcome
The problematic pattern of prescription opioid use was successfully treated using sublingual buprenorphine. The fact that this molecule does not routinely show in drug test panels should not be considered a liability in the overall context of clinical monitoring.
Cost containment can be realized by limiting formal buprenorphine assay. The absence of more easily detectable molecules such as morphine or oxycodone, which buprenorphine is designed to replace, reassures the clinician that treatment adherence and clinical stability has been achieved.
The patient on buprenorphine with negative results of UDT indicates compliance and stability with the new drug regimen.