I will introduce this topic by typing my response to a reader who asked whether buprenorphine, the active ingredient in Suboxone, shows up in urine drug tests. More specifically he asked whether companies have the ability to test for buprenorphine. I will end the post with a question… so please stick around to the end!
There are tests out there—multi-panel dipstick tests– that react ‘positive’ to Suboxone in the opiate panel. Or at least there used to be; I used to see that reaction with a brand of tests I no longer remember, that I used several years ago. For the past couple years, every dipstick brand that I have purchased has responded ‘negative’ to buprenorphine (or naloxone for that matter) as an ‘opiate,’ and positive in the ‘buprenorphine’ column (i.e. so I know that the urine truly contained buprenorphine). I pay more for dipstick tests that have a separate panel for buprenorphine, but yes, that test is available if a company wants it. From what I have heard from owners of companies or from people privy to the inner workings of companies, some businesses will do a dipstick first, and then send only positive samples to a lab for more formal testing in case a firing is challenged in court. They do the dipstick first because it is MUCH cheaper- $5 for a dipstick test, and several hundred for a laboratory test for several substances. It costs more for each test at the lab, so companies will only have the lab test for the substance of concern.
I assume that it comes down to the attitude of the company, but there may be issues that I am not aware of. I assume that some HR folks know what bupe is, and deliberately choose not to test for it, believing that it is a medication in most cases and not a drug of abuse. I’m sure there is a company somewhere that tests for bupe to catch any sign of even ‘prior’ addiction, but that has not been the experience of the people who have written to me. I have not heard from anyone who tested positive for buprenorphine in a random test—but I will put the question on my blog and see what comes up!
So there is my question: has anyone tested positive for buprenorphine in the workplace? Has anyone tested negative who takes buprenorphine? Please share your responses in the comment section below, so that I will have more than guesses for people who write. My attitude, for what it is worth, is that your medication list is your own business, providing that the medication does not influence your ability to perform your job. But I realize that the answer to the question can be complicated. For example, I was first treated for opiate dependence in 1993, and was completely ‘clean and sober’ for many years, active in 12-step Recovery and regularly attending meetings. Every two years I received a re-appointment packet at the hospital where I worked, and one question was ‘Do you have a chronic illness that affects your ability to care for patients?’ I knew what the question was getting at— but to my way of thinking, as a person who had been clean for several years and who was never planning on using again, the correct answer was clearly ‘no, I had no illness that affected my care of patients.’ But when I relapsed in the year 2000 the hospital made much of my answers to that question, reporting to the Board that among my other (much more significant) transgressions, I lied on my re-appointment packets. I was going to defend myself by saying ‘it depends on what the meaning of ‘is’ is…’ but someone else used that excuse before I could use it!!
The problem people face with workplace drug testing– at least something that would be considered a problem for those sympathetic to people on buprenorphine– is that people are often asked to provide a list of the medications they are taking BEFORE the test. If not for that question, they could go take the test and explain themselves in the event of a positive result. But if asked about medications beforehand, the worker must decide whether to disclose a history of addiction to an employer who may be overly judgmental, or keep the medication use private and risk being accused of lying.
To those who are going to write that ‘taking buprenorphine is impairing a person and therefore the person must put the info out there,’ I will say in advance that my patients on buprenorphine, who take the medication properly, are NOT impaired by any definition of the word. They are completely tolerant to the mu receptor effects and are getting no ‘opiate effect’ from the medication. I will also point out the double standard applied to addiction. A person with a history of epilepsy is at risk for losing consciousness while operating a crane from a seizure. A person with diabetes is at risk for the same from a hypoglycemic reaction. Someone with heart diseast could drop dead of a lethal arrhythmia while driving a school bus filled with children. Should opiate addicts who are doing the ‘right thing’ and keeping their addiction in remission be forever identified as ‘addicts’ to employers?
As always, thanks for your comments; please also be sure to join the forum if you have not already. You will note that when leaving a comment, it will take a day or so to get read and approved; I do that because there are people who have nothing better to do, apparently, than respond that I am ‘a little bitch’ or call me some other name– for reasons that are not always entirely clear! When I read such comments I always get a mental image of Mr T. saying ‘I pity the fool!’ (then I think of the scene in Pee Wee Herman’s Big Adventure where Mr. T. says ‘I pity the fool… who doesn’t eat my cereal!) I guess you really have to be there.
SneakyElephant · March 4, 2010 at 9:26 am
I don’t know what drug tests are like in the US or the military, but at the clinic I attend in the UK it is as follows:
The counsellor gives you a little plastic pot with a screw top and a 2 part tube arrangement inside. There is also a graduated sticker on the side with boxes for amphetamines, cocaine, marijuana, benzodiazepenes, opiates and buprenorphine. You pee in the pot and hand it back. The counsellor then fiddles around with the lid and screws it on, making sure that the sample covers the ‘testing’ part of the little gadget inside. He waits for a minute or so, then checks the scale. Each box has a sensitive reagent which shows as a little bar in the box. One bar is a positive reading, two bars is negative.
This test seems to be pretty accurate. For example when I took my first test, it showed positive for not only heroin, but also benzos, which I never knowingly take. It turned out that my last dealer had been cutting the gear with crushed up diazepam (valium) pills to bulk it out. Also, after about a month of sub treatment I smoked half a joint of really crappy moroccan hash one saturday night. On the following wednesday I had a test. My counsellor went through the procedure, then read the result on the scale. He turned to me with a little smile and asked if I had smoked any weed lately.He showed me the scale, and sure enough the marijuana box showed positive. Of course there was no denying it, and it wasn’t a problem as it’s not really considered a big deal over here unless you’re dealing it. However I was quite surprised at the sensitivity of the test, it really was only a very skinny half-doobie that I smoked. I should point out that the test also showed a positive for buprenorphine, as it should.
There is also another test, which is like a little flat white lollipop on a stick. The guy unwraps it and gives it to you. You place it between your cheek and gum, and leave it there for a couple of minutes. The counsellor then takes it back and bags it up with your case details printed on the side. I don’t know how this thing reacts, whether it changes colour later or what. All I know is that it tastes FOUL, like animal glue. I suspect that it just takes a sample of epithelial cheek cells, which are lab tested at another site for substance abuse.
rogue44 · December 13, 2010 at 10:39 am
I get tested through two different agencies. I am on 2 and 1/2 8 mg Suboxone films a day. I take them every morning when I wake up. Yet, when tested for Suboxone they are not showing up! They think the worst, of course. My recovery is in jeopardy for they may remove me from the program.
Has anyone ever had this happen or know why it could be happening? I need advice, they also have children and youth involved now and I am at risk of losing my baby if they do not get this straitened out!!!
I'm me · November 6, 2017 at 10:43 am
Okay I just have a question… I am on Suboxone maintenance.. I was just told today that I’m positive for bupronorphone, but negative for naloxone.. how is that even possible? Sometimes I don’t take both in a day, but I always take at least one. And I just don’t understand how one would be showing up and the other not.. I do sometimes administer them rectally if I’m feeling sick, because of the taste, but I have consistently take my Suboxone.
Jeffrey Junig MD PhD · February 2, 2018 at 9:21 pm
I’m sorry, but I don’t knwo the answer to that one. Understand though that the absorption and metabolism of both buprenorphine and naloxone will vary depending on whether you take it rectally or sublingually! With sublingual dosing, 70% of a dose of Suboxone is eventually swallowed. Dosing rectally probably increases the amount absorbed from 30% to 90%. Those differences may result in accusations that you are doing something wrong…. which you are, frankly. I’d say, just take it the usual way.