buprenorphine levels

Buprenorphine Post
Posts: 17

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

Thanks for the input.

Posts: 90

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

Dr. Colleen

I have the answer to your inquiry, and it is a surprising and a discouraging one.

THERE ARE NO STANDARDS, GUIDELINES, OR EVEN RESEARCH regarding correlation of patient buprenorphine and norbuprenorphine quantitative levels with dose.

I researched this exhaustively a couple of years ago and carefully reported my findings here. I will try to locate that and identify it.

Only two quite old, extremely small, and inadequate studies addressing the question whatsover. I spoke with ASAM speakers. Large laboratory chiefs. Nothing.

After finally locating the top expert on the question at a national lab in Atlanta I was finally told, "You must simply interpret these results in accord with your own experience."

A few months ago I did again bring this matter up with officers of a central lab which happens to be headquartered in Nicholasville, KY -- I notice you practice in KY, as do I. He indicated that they were initiating a study of this in their lab, and confirmed again that no good data or guidelines currently exist.

We do indeed see quantitatitive levels which differ by a level approaching even two orders of magnitude (i.e., 100 fold) in patients prescribed identical regimens.

We have no hard data whatsoever with which to evaluate these findings. We know nothing of metabolic idiosyncrasies.

I have not researched the literature on this since my labored search at the time of my initial thread. If there has been work of value on this question since that time it certainly has not come across my radar.

This obviously is of considerable importance to us, primarily to be able to evaluate compliance as well as the likelyhood of medication diversion.

Posts: 111

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

While I have no data concerning Buprenorphine levels relating to dose, I can say that there speed of metabolism varies and can be genetically influenced. Also the length of time since last dose can affect the levels. I have patients taking 16 mg daily who will have the same or lower levels as patients taking 2 mg daily. Millennium Labs has confirmed to me there is no correlation as to dose and level. Most likely what the state Medicaid is looking for is an accurate test confirming the presense of buprenorphine and metabolites.

Posts: 198

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

I've had some patients in the clinic on observed dosing of a 2mg dose that it did not show up in laboratory testing. Higher doses have always showed up where I work. Our lab prints on the results form a scale roughly correlating dose to expected serum levels, but I don't know how accurate that is considering all of the variables in metabolism.

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