Definitive urine drug testing in office-based opioid treatment: a literature review

Abstract

Individuals who receive buprenorphine treatment for opioid use disorder in office-based settings may be at risk for, or have a history of, polysubstance use. Urine drug testing is an important clinical tool for monitoring medication adherence and patient stability; and screening for illicit drug use and dangerous drug-drug interactions. This article is intended to educate practitioners in office-based opioid treatment settings on selecting appropriate substances for a definitive drug testing panel that are known to be used concurrently, sequentially, or in combination with buprenorphine for opioid use disorder. It is also intended to educate such practitioners on selecting appropriate testing technology to reduce risks to the health and safety of patients prescribed buprenorphine for opioid use disorder. In developing this article, the author conducted a search from May 2018 through December 2017 of peer-reviewed and government-supported articles in electronic databases. The literature showed that several common substances are often abused in conjunction with certain other substances, increasing the risk of serious adverse events, including death.

Whether used on their own, concurrently, sequentially, or in combination, substances of abuse carry significant health risks. Definitive urine drug testing, given its high specificity and sensitivity, can accurately identify the use of specific prescription medications and illicit substances that, especially when taken with buprenorphine or other substances, may cause harm to a patient. When testing for buprenorphine and other opioids; sedatives, hypnotics, and anxiolytics; cocaine; amphetamines; and PCP and other club drugs, providers in office-based opioid treatment settings are strongly advised to use definitive urine drug tests as the primary testing methodology. In addition, practitioners must be able to identify all other substances that a patient may be consuming, taking into consideration the patient’s historical and current drugs of choice, given that concurrent use with buprenorphine or other substances may cause serious adverse events. This article highlights the pressing market demand for comprehensive, definitive urine drug testing at a more reasonable cost.

Keywords:

• Urine drug testing
• presumptive urine drug testing
• definitive urine drug testing
• office-based opioid treatment
• substance use disorders
• opioid use disorder
• buprenorphine
• medication treatment
• polysubstance use

Acknowledgments

The authors would like to thank Nicholas Workman and Anthony Lovato for their research assistance in drafting this article.

Declaration of interest

All authors are affiliated with Ideal Option, a private behavioral health services clinic. Ideal Option supported the preparation of the manuscript to enhance patient care and public health by broadly disseminating to other health care clinicians the recommendations the authors developed for Ideal Option. Ideal Option provided salary compensation to J.A. and K.E. Ideal Option provided consulting fees to A.G.B., who is a consultant to other health care organizations and provides expert-witness services on issues related to UDT in addiction medicine. The authors retained final decision-making and have the sole responsibility for the writing and contents of this article.