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Addiction, Health Alerts, Opioid Epidemic

Using Naloxone Levels To Detect “Spiked” Urine Tests

Urine Drug Testing

Medication-Assisted Treatment (MAT; also known as Medications for Opioid Use Disorder; MOUD) is a lifeline for so many in treatment with Opioid Use Disorder. In particular, the combination product of buprenorphine-naloxone (Suboxone) has saved lives by preventing overdoses, reducing IV heroin-associated infectious diseases – such as HIV and Hepatitis C – and by improving patient’s chance of staying in treatment.

Given the importance of buprenorphine treatment, patients at times can feel pressure to demonstrate that they are staying on the medications, even if they haven’t been able to stick with the treatment plan. This can result in feelings of shame, fear of repercussions, or a desire to not disappoint their provider. As part of the disease process, patients may even be motivated by the desire to divert or sell some of their medications.

Due to these pressures, patients can occasionally engage in a practice where they “spike” the original drug directly into their urine. In this case, buprenorphine will be detected in a patient’s urine, but it will not have been actually consumed. This practice will be missed on any common immunoassay-based screening method. However, if confirmation testing is ordered, both the original drug (also known as the parent drug) as well as the drug’s metabolite (norbuprenophrine) will be detected.

Providers have increasingly relied upon the ratio of the metabolite norbuprenorphine to the original drug (buprenorphine), known as the N:B ratio, to identify this practice of spiking urine samples with drug. Since naloxone is also part of the Suboxone combination product, there has been some speculation that naloxone levels can also be used to highlight this practice.

Aspenti conducted a study to determine if elevated naloxone levels can be used to flag possible cases in which patients have spiked their urine with drug. Though only a small case study, this was the largest evaluation of urinary naloxone concentrations to date. We found that naloxone levels (>2000 ng/ml) may be useful clinically to flag cases of possible urine spiking with Suboxone.

To learn more about this recent study, please see the article here: https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-020-0178-9.

Chief Medical Officer, Aspenti Health™ and Clinical faculty, Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont.

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