buprenorphine levels

Buprenorphine Post
adavid
Posts: 64

Postby adavid » Wed Mar 30, 2016 5:50 am

It is possible for the patients to be taking bup daily and the specimen they submit to have no bup in it. This is common if they submit a friend's urine. We often see this and we request a second specimen, this time OBSERVED and magically there is now bup but also benzos or cocaine or even opiates. When these people resort to submitting a fake urine they often forget that we look for bup too.

If there is no bup in the observed specimen then, I am sorry to tell you, they are just lying about taking it.

Dave
Posts: 187

Postby Dave » Wed Mar 30, 2016 5:50 am

NoDrugs, I have never seen any person who tested negative for buprenorphine on a urine test who insisted he was taking the bupe. I think your two patients are good liars. I know some of them are very convincing. The only possible exception I can imagine is your control urine test being faulty. I have never encountered that situation either.

DrBallester
Posts: 84

Postby DrBallester » Wed Mar 30, 2016 5:50 am

quote:
Originally posted by NoDrugs4u

Related question - is there any way someone on 8mg daily could test negative for buprenorphine in a urine test? I have two patients in that situation that vehemently claim they are taking their medication.



POC or lab?

Bruni
Posts: 49

Postby Bruni » Wed Mar 30, 2016 5:50 am

quote:
Originally posted by NoDrugs4u

Related question - is there any way someone on 8mg daily could test negative for buprenorphine in a urine test? I have two patients in that situation that vehemently claim they are taking their medication.


Is the lab trustworthy and the specimen properly handled?
I was doing point of contact testing with Express Diagnostics 10 drug cup and a separate buprenorphine dipstick. The little pink lines were sometimes impossible to distinguish from a pink blob where there should have been a solid, well demarcated bar. Many negatives. I switched to relying on a specialty lab (Burlington Labs) and enjoy the certainty of test interpretation by well trained experts. I get no more negative bupe levels and don't wake up from dreams of pink bars disappearing.

Bruni

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Wed Mar 30, 2016 5:50 am

Related question - is there any way someone on 8mg daily could test negative for buprenorphine in a urine test? I have two patients in that situation that vehemently claim they are taking their medication.

Bruni
Posts: 49

Postby Bruni » Wed Mar 30, 2016 5:50 am

quote:
Originally posted by rickbennettmd

Bruni
My posts concerning the information I gathered on buprenorphine
serum concentrations was in the thread "Selling bup" in
late June 2014


Thanks, I'll look'em up.

Bruni

rickbennettmd
Posts: 90

Postby rickbennettmd » Wed Mar 30, 2016 5:50 am

Bruni

My posts concerning the information I gathered on buprenorphine
serum concentrations was in the thread "Selling bup" in
late June 2014

I've confirmed this with labs. That is, there is no data correlating serum concentrations of bup/norbup in the literature. None. Two tiny lousy studies done years ago. I'm quite sure this is true for urine levels, also.

re urine levels: I correct all urines to a concentration of 1.01 for standardization. But I'm a serum guy, not a urine guy.

If corrected for concentrstion, don't the urine concentrations vary in sync and value with the serum concentrations?

This is a great topic. Very important issue.

Jeremy K
Posts: 109

Postby Jeremy K » Wed Mar 30, 2016 5:50 am

Dr Colleen:
Fellow KY'ian here. Just wanted to mention (you probably know this but...) while the actual level of Buprenorphine in the urine may vary based on many factors, the Norbuprenorphine level will usually be higher than the Bup. Also, if one sees a Bup level 'off the chart' and a very low or 0 Norpbup level, then you can reasonably conclude that the patient is not taking the Rx and has 'doctored' their pee.

Bruni
Posts: 49

Postby Bruni » Wed Mar 30, 2016 5:50 am

quote:
Originally posted by rickbennettmd

Dr. Colleen
THERE ARE NO STANDARDS, GUIDELINES, OR EVEN RESEARCH regarding correlation of patient buprenorphine and norbuprenorphine quantitative levels with dose.
....
We know nothing of metabolic idiosyncrasies.



Please do find your notes. I want to read the information.

Bruni

robertsonjon
Posts: 32

Postby robertsonjon » Wed Mar 30, 2016 5:50 am

I check urine or saliva at each visit, the amount detected in even my most reliable patient can range from a thousand to five hundred thousand ng/mL depending on the number of hours before the test that the medication was taken. I don't see how any standardization could be done or useful based on the high variability, especially in saliva for buprenorphine. The amount of norbuprenorphine also varies, but is generally 5-200 ng/mL.


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