Suboxone drug screen question...

[garnetgirl29, BSN, RN]

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??

[Meriwhen, ASN, BSN, MSN, RN]

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.

[garnetgirl29, BSN, RN]

We do a COWS scale before starting our clients on suboxone, and once they start, the protocol lasts for 5 days. They begin with 4mg BID, and taper down to 2mg 1x on the last day. This client was on day 4. So, I'm assuming then, that he snuck something into the clinic and was still using while in the clinic?? He should've been at least 2 days clean before starting the suboxone, so at the point that he asked for the urine drug screen, he should've been 6 days opiate free. If he used while in the clinic, the effect would be blocked but he would still test positive?

We are a non-medical clinic, so the urine drug screen cups are all we have available. If I remember correctly, his only prescribed med, other than suboxone, was celexa. I even thought maybe the cup was defective & gave him another. Same result.

Thank you for the info Meriwhen

[Meriwhen, ASN, BSN, MSN, RN]

If he used while in the clinic, the effect would be blocked but he would still test positive?

The fact that the contraband wasn't effective doesn't change the fact that it's still in his system. So yes, he could still pop positive if he had relapsed.

If I remember correctly, his only prescribed med, other than suboxone, was celexa. I even thought maybe the cup was defective & gave him another. Same result.

AFAIK, citalopram (Celexa) doesn't tend to cause false positives for opiates. However, there's a few OTCs that can cause false positives...they're not likely to but possible.

[garnetgirl29, BSN, RN]

Thank you!!

[Jonecour3096]

Suboxone has changed my life! We need more availability at less costs and maybe make a dent in heroin abuse!

[Jules A, MSN]

Suboxone has changed my life! We need more availability at less costs and maybe make a dent in heroin abuse!

As with anything it is about risks vs benefits. This medication is not the holy grail, imo.

That said I wonder if the OP wasn't referring to Subutex which is more commonly prescribed on inpatient units for quick detox.