Introduction Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 References

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.


The Test

Urine drug test done by GC/MS

The Test Results
The results are negative for opioids including buprenorphine.

Given the clinical scenario, the UDT result can best be interpreted as:





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Buprenorphine is not detected in routine urine testing unless the lab has a specific methodology to identify it. Similarly, detection limits for this analyte vary: some labs may report “not detected” even if the drug is present if the concentration of drug is below the reporting level for that lab. Clinicians may order a specific screening urine drug test for buprenorphine. The naloxone component in the combination tablet may or may not be detectable with methodologies used and quantity of drug absorbed sublingually.

Note: Some labs may include buprenorphine in a standard immunoassay screen. Confirm ability, availability and cost of this testing option with the testing laboratory.

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.

Negative test results, in the appropriate setting can be reassuring in the context of achieved clinical goals.

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.


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Case 1:
Low back pain

Case 2:
High-risk patient

Case 3:
Activity-related pain

Case 4:
Escalating opioid doses

Case 6:
Comorbid depression & anxiety