At my clinic, we use suboxone to detox from opiates(inpatient). I was under the impression, that since the suboxone blocks the opiate receptors in the brain, any opiates in the clients system will flush out more quickly & if the client were to use an opiate while on suboxone, the effects would be blocked.
I'm getting mixed answers as to whether suboxone shows up on a drug screen. I had 4 clients toward the end of their suboxone protocol ask me for a drug screen the other day. 3 tested clean and one tested positive for opiates. He was very upset because his employer was going to drug test him & he needed to be clean(discharging the next day). So, why would he test positive while the others did not??
Apr 23, '13
by Meriwhen, ASN, BSN, RN Senior Moderator
Suboxone binds more strongly to the receptors than opiates do: if the patient still has opiates in their system and takes suboxone, the suboxone will displace the opiates and induce a rapid and massive withdrawal. Should the patient take opiates while on suboxone, the opiates will likely have minimal to no effect.
I don't know the protocol your facility follows for suboxone use. But in the detox programs I've worked in on both sides of the country, suboxone isn't used to detox a patient currently under the influence of opiates. The patient is only started on suboxone after they have ceased using opiates for a period of time and are in moderate to severe withdrawal. At that point, suboxone is then introduced and the dose titrated until the withdrawal symptoms abate.
As far as showing up in drug testing...it will not show up as being positive for opiates in your standard urine dip. However, suboxone could show up in qualitative testing that is specifically looking for it.
I've given plenty of urine drug screens to suboxone patients in the last few years, and have not had one false positive due to suboxone come up. The positive tests that did show up were due to the patient relapsing, not suboxone.
This isn't to say that a positive for opiates can't happen, but the chances are very small. It's also possible that another psychotropic caused the positive result. I would ask for a gas chromatography–mass spectrometry (GC-MS) or other qualitative analysis test be run on the sample--that would identify exactly what caused the positive result.
Last edit by Meriwhen on Apr 24, '13