What Is the Best Way to Pass a Drug Test After Using Suboxone
J Pharmacol Pharmacother. 2012 Jan-Mar; 3(i): 15–19.
A urinalysis-based study of buprenorphine and non-prescription opioid use amid patients on buprenorphine maintenance
Yatan Pal Singh Balhara
Section of Psychiatry and De-addiction, Lady Hardinge Medical Higher and SSK Hospital, New Delhi, Republic of india
Raka Jain
1 National Drug Dependence Treatment Eye, All Bharat Found of Medical Sciences, New Delhi, India
Abstract
Objectives:
To understand the pattern of employ of opioid-substitution therapy (OST) and opioid abuse amid patients on buprenorphine maintenance using urinalysis.
Materials and Methods:
The study was conducted at a third care de-habit middle. Nosotros reviewed the laboratory record of all consecutive urine samples sent for drug analysis over a period of 1 year. In all, 179 consecutive urine samples were included in the assay. The chi-foursquare test was used to compare opioid abuse amidst those testing positive and negative for buprenorphine on urinalysis. Additionally, in order to assess the potential impact of the prescribed consecration and maximum dose of buprenorphine on the findings, nosotros carried out the independent-samples t test. Level of statistical significance was kept at P<0.05 for all the tests.
Results:
Urinalysis failed to detect buprenorphine in 44.7% of the samples. Rate of detection of dextropropoxyphene was significantly higher amongst buprenorphine-negative samples (P<0.005). The prescribed induction dose of buprenorphine was significantly lower amongst those testing positive for heroin. This was found for both buprenorphine-positive (P<0.005) equally well every bit buprenorphine-negative samples (P<0.005).
Conclusions:
These findings back up the routine use of urine drug screening among individuals on OST.
Keywords: Buprenorphine, opiate exchange therapy, urinalysis
INTRODUCTION
Opioid dependence adversely impacts personal wellness and economical productivity and is associated with many social and legal bug. There is high gamble of relapse after handling for opioid addiction. As function of impairment minimization, opioid substitution therapy (OST) is started for such people. Buprenorphine has been established equally a prophylactic and cost-effective long-term alternative to methadone in exchange therapy for opioid dependence. It has shown benefits similar to those of methadone in retaining patients in handling and improving quality of life and overall health condition.[one] However, concerns have been expressed about the compliance with treatment and diversion of the prescription buprenorphine.[2–iv] Also, continued non-prescription opioid use has been documented amid those on OST with buprenorphine.
The reliability of cocky-study about non-prescription drug use and compliance with prescribed buprenorphine among opioid abusers remains debatable.[v] It has been recommended that the OST exist corroborated and monitored using objective measures such every bit urine drug screening.[6] Utilize of urinalysis findings when combined with self-report could provide important insights into the pattern of OST use and not-prescription opioid abuse among patients on buprenorphine therapy. Also, it provides objective evidence of the compliance with the prescribed medication.
International guidelines on buprenorphine prescription recommend routine apply of some objective method to validate cocky-report of drug use pattern. Urine drug screening is the virtually commonly used and the most cost-constructive method for this purpose.[vii] The guidelines for use of buprenorphine in Bharat are in accordance with the international recommendations. All the same, utilise of routine urine drug screening to ensure compliance is not recommended in these Indian guidelines.[viii] Lack of resources and technical expertise are possible reasons for this.
The electric current study aims at understanding the pattern of use of OST and non-prescription opioid employ among patients on buprenorphine maintenance. Nosotros have used findings from urinalysis as an objective measure for this purpose.
MATERIALS AND METHODS
We reviewed the laboratory records of all urine samples sent for drug assay over a period of one year at a tertiary-care de-addiction centre. All cases with buprenorphine prescription for OST during this catamenia were included in the study. All the subjects were being treated as outpatients and were existence administered the medication from the treatment center on a biweekly basis.
At this centre, urine samples sent for drug evaluation are screened for common drugs of abuse in the region also as medications prescribed as OST from the heart, which include heroin (detected equally morphine), buprenorphine, dextropropoxyphene, and benzodiazepines. A supervised urine sample (50 ml) is collected from patients coming for treatment at the de-addiction center. It is and so sent to laboratory for assay. A standardized modified hydrolysis method followed past thin-layer chromatography (TLC) is used for detection of drugs in the urine.[9,ten] The detection limit for urinalysis in the laboratory is 0.5 μg/ml for morphine (heroin) and dextropropoxyphene, 0.ii μg/ml for benzodiazepines, and ane.0 μg/ml for buprenorphine.
Data analysis was carried out using SPSS® version 17. The pattern of prescription buprenorphine use and not-prescription opioid apply was assessed using frequency distribution. Nosotros used the chi-square test to compare non-prescription opioid use among those testing positive and negative for buprenorphine on urinalysis. Additionally, in order to assess the potential impact of the prescribed consecration and maximum dose of buprenorphine on the findings, we carried out the contained-samples t test.
Weather condition of anonymity and confidentiality, as recommended in the institute'southward upstanding guidelines, were strictly adhered to during the study.
RESULTS
A total of 179 consecutive urine samples received over a 1-year flow were included in the study. The sociodemographic profile of the study sample and the dose of buprenorphine during the consecration and maintenance phases is presented in Table one.
Tabular array one
Sociodemographic profile and buprenorphine prescription dose for the study sample (northward=179)
Buprenorphine was detected in 99 (55.iii%) of the samples. Heroin and dextropropoxyphene were detected in 10 (5.6%) and 14 (7.viii%) of the samples, respectively. Hence, the rate of non-prescription opioid use was 13.four% [Table 2; Figure ane]. The rate of detection of dextropropoxyphene was significantly college amidst buprenorphine-negative samples (chi-foursquare 14.25, df=ane; P<0.005). The proportion of urine samples testing positive for heroin was like in buprenorphine-positive samples and in buprenorphine-negative samples (chi-square 0.08, df= 1; P=0.76).
Table two
Urinalysis findings for opioid employ for buprenorphine-prescribed opioid-dependent subjects
Findings of urinalysis for the full sample, buprenorphine-positive samples, and buprenorphine-negative samples
The induction dose of buprenorphine was significantly lower among those testing positive for heroin than in those testing negative. This was constitute for both buprenorphine-positive (north=37; mean dose 2.11±0.78 mg/day vs 6.xi±v.38 mg/day; t=–six.94, P<0.005) as well every bit buprenorphine-negative samples (n=26; hateful dose 1.77±0.76 mg/twenty-four hours vs 6.17±v.49 mg/24-hour interval; t=–five.09, P<0.005) [Table iii].
Table 3
Average consecration daily dose of buprenorphine for buprenorphine-positive and buprenorphine-negative urine samples
However, no such departure was observed for the maximum dose of prescription buprenorphine (t=–3.435, P=0.74 and t=–0.214, P=0.847 for buprenorphine-positive and buprenorphine-negative urinalysis, respectively). Similarly, no departure was observed for prescribed dose of buprenorphine among dextropropoxyphene-positive (t=–0.nineteen, P=.85) and dextropropoxyphene-negative (t=one.34, P=.eighteen) urine samples among urine samples testing positive for buprenorphine. As well, no differences were observed for prescribed dose of buprenorphine among dextropropoxyphene-positive (t=0.076, P=.94) and dextropropoxyphene-negative (t=1.08, P=.32) urine samples amid urine samples testing negative for buprenorphine.
The independent-samples t test failed to find whatever pregnant departure between the dose (induction dose as well every bit maximum dose) of the prescribed buprenorphine and buprenorphine urinalysis condition (n=37, t=–0.032, P=0.974; northward=26, t=0.641, P=0.524).
Give-and-take
The current study aimed at agreement the pattern of apply of OST and non-prescription opioid use amidst patients on buprenorphine maintenance. Nosotros used findings from urinalysis equally an objective indicator for this purpose.
A total of 179 consecutive urinalysis qualified for inclusion in the study. The rate of not-prescription opioid utilize was thirteen.4% in the current study. The rate of non-prescription opioid utilise among individuals on buprenorphine therapy has been constitute to vary across studies. It was establish to be around 20% in a comparative study of buprenorphine and methadone.[xi] Another study by Gerra et al. reported information technology to be around 21%.[12]
All the samples in the current written report were from opioid-dependent patients on OST with buprenorphine. Still, urinalysis failed to detect buprenorphine in 44.seven% of the samples. This noncompliance rate is much higher than the usually observed rate of 30%.[13] This suggests a significant proportion of the individuals were not using the prescribed buprenorphine. Diversion of the prescribed buprenorphine is a possible explanation for this finding. Such diversion of prescription buprenorphine has been reported from different countries, including Australia, England, Finland, French republic, Ireland, New Zealand, and Scotland.[four]
Information technology is likely that some of those testing positive for dextropropoxyphene (with or without their sample being buprenorphine-positive) might be using dextropropoxyphene in addition to the buprenorphine they were receiving through the OST program. Reports of such 'doc shopping' behavior among opioid abusers take come up from other settings equally well.[fourteen] There could be dissimilar explanations for such beliefs. To begin with, lack of difference in the prescribed dose of buprenorphine amongst those testing positive and negative for dextropropoxyphene makes the possibility of inadequate dose of prescribed buprenorphine unlikely. However, the stringent requirements of regular follow-upwards for buprenorphine (daily to twice weekly) might bulldoze these individuals to ration their buprenorphine supply, substituting it in role with dextropropoxyphene. The possibility of diversion cannot be ruled out. Some of those registered with buprenorphine OST might be diverting it, while using dextropropoxyphene themselves. This is a likely explanation for those testing positive for dextropropoxyphene and negative for buprenorphine. The high street value and restricted availability of buprenorphine in the open market makes it a likely candidate for diversion.
Different patterns of treatment non-adherence to buprenorphine prescribed as OST accept been observed. These include: (a) diversion to the black market place, (b) not-adherence to prescriber's recommendations almost the dose to be used, (c) concurrent employ of other drugs or booze, and (d) unsanctioned administration of buprenorphine (by injection or sniffing).[xviii] Two of these possibilities, (b) and (c), are supported past the urinalysis findings of the current report. The possibility of diversion to the black market and injecting utilize could be confirmed through focus-grouping discussions (FGD) and primal informant interviews (KII) with the service users.
Apply of an inadequate dose of buprenorphine, peculiarly during the early phases of therapy, is a likely crusade of continued use of heroin by opioid abusers. This was observed in the current study, where the consecration dose of prescribed buprenorphine was significantly lower amongst the heroin-positive urine samples. This was observed for those concomitantly testing positive for buprenorphine likewise those testing negative for buprenorphine. Gerra et al. found high doses of buprenorphine to be more effective than low doses in reducing non-prescription opioid use (f=nine.7, P<0.05).[12] As well buprenorphine-maintained patients who showed morphine-positive urines had significantly lower doses than those with negative urine screen findings (7.7±0.6 mg/day vs 11.3±0.5 mg/day; t=ii.53, P<0.05).[15] In the current study, the induction dose of buprenorphine was significantly lower among morphine-positive also equally buprenorphine-positive urine samples (hateful dose 2.11±0.78 mg/day vs vi.xi±5.38 mg/day; t=–half dozen.94, P<0.005). Similarly, the consecration dose of buprenorphine was significantly lower amongst morphine-positive but buprenorphine-negative urine samples (mean dose 1.77±0.76 mg/day vs vi.17±v.49 mg/day; t=–five.09, P<0.005).
While some of these nether-prescribed individuals may have used heroin as a 'top-up,' others may have discontinued using buprenorphine because of inadequate satisfaction of drug hunger and poor withdrawal management. Inadequate dosing of buprenorphine is a mutual reason for noncompliance and continued not-prescription opioid utilise.[xv]
While utilise of low doses of buprenorphine at consecration has been associated with poor retention in treatment,[16] rapid up-titration of buprenorphine has been found to improve compliance.[17] Prescription of an adequate dose of buprenorphine has been found to protect against physician-shopping behavior amongst opioid abusers.[15] The high ceiling effect for opioid agonist activity with buprenorphine makes it relatively safer in loftier doses.[eighteen] Prescribers must be aware of this fact and should non under-prescribe. Notwithstanding, prescribers should also exist alarm to the possibility fatal accidents due to excessive dose of buprenorphine as a result of intravenous misuse or concomitant use of other sedative drugs such equally benzodiazepines, which is ever a possibility in this grouping.[xix]
OST using buprenorphine-naloxone has been found to be safe and effective, with limited diversion rates.[20,21] This could be an alternative to the apply of plain buprenorphine for OST.
The use of urine drug screening in the electric current study has helped us understand the blueprint of use of prescription buprenorphine as well as non-prescribed opioids (including illicit heroin) amid those using OST. The reliability of self-study well-nigh not-prescription drug employ and compliance with prescribed buprenorphine has been, and remains, debatable.[5] International guidelines recommend routine use of some objective method to validate self-report of the service users regarding the drug apply patterns.[22] Urine drug screening is the most commonly used and generally nigh cost-effective method for this purpose.[23] The findings from the current report too back up the routine utilise of some objective measure to corroborate self-reported drug use by those on OST. Though Indian guidelines on the use of buprenorphine as OST are in accord with the international recommendations, utilise of routine urine drug screening to ensure compliance is non recommended in these guidelines.[viii] This could exist due to lack of resources and technical expertise in the country. Notwithstanding, at that place is a demand to include routine urine drug assay as an integral component of the OST program. This would help in improving monitoring and thus let timely intervention.
The current study made use of the urinalysis findings. It did non explore the perspectives of the service users on the issues. It would exist informative to explore these problems using FGD and KII among those on OST.
CONCLUSIONS
The findings from the current study provide important insights into the pattern of apply of OST as well every bit that of non-prescribed opioids (including illicit heroin) among individuals on buprenorphine therapy. These findings back up routine use of urine drug screening among individuals on OST.
Footnotes
Source of Support: Nil
Disharmonize of Interest: None declared.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284030/
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