title: Interpretation of urine drug testing results in patients using transdermal buprenorphine preparations for the treatment of chronic noncancer pain.
abstract: OBJECTIVE
  To determine whether the prevailing liquid chromatography and tandem mass spectroscopy assay (LC-MS/MS) assay designed to monitor buprenorphine compliance of the sublingual formulation used in the substance abuse treatment setting can be extrapolated to the transdermal formulation used in the chronic pain treatment setting, which is 1000-fold less concentrated.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Self-reported compliant patients using the transdermal or sublingual formulations of buprenorhphine. Transdermal patch application was also visually confirmed during clinic visits.
  
  
  METHODS
  Urine drug test results from a LC-MS/MS were compared between samples from transdermal and sublingual patients.
  
  
  RESULTS
  While all sublingual patients tested positive for at least one metabolite of buprenorphine, only 69% of the transdermal patients did so. In addition, the most abundant metabolite in the transdermal patients was buprenorphine-glucuronide, as compared with norbuprenorphine-glucuronide in sublingual patients.
  
  
  CONCLUSIONS
  These data suggest that currently available urine drug tests for buprenorphine, including the more expensive LC-MS/MS based assays, may not be sufficiently sensitive to detect the metabolites from transdermal buprenorphine patients. This study highlights the need to evaluate the value and sensitivity of urine drug tests given the wide range of buprenorphine dosing in clinical practice. These results underscore the need for additional cost benefit analyses comparing different confirmatory drug testing techniques including many commercially available drug testing options. © 2014 Wiley Periodicals, Inc.
authors: Department of Neurosurgery, University of Rochester, New York, 14642, USA.
authors: John D
authors: JD
authors: Markman
authors: Brown University, Rhode Island, 02912, USA.
authors: William A
authors: WA
authors: Barbosa
authors: Department of Anesthesiology, University of Rochester, New York, 14642, USA.
authors: Jennifer S
authors: JS
authors: Gewandter
authors: Department of Neurosurgery, University of Rochester, New York, 14642, USA.
authors: Maria
authors: M
authors: Frazer
authors: Department of Neurosurgery, University of Rochester, New York, 14642, USA.
authors: Shirley
authors: S
authors: Rast
authors: Department of Neurosurgery, University of Rochester, New York, 14642, USA.
authors: Michelle
authors: M
authors: Dugan
authors: University of Rochester, School of Medicine and Dentistry, New York, 14642, USA.
authors: Kiran
authors: K
authors: Nandigam
authors: Department of Neurosurgery, University of Rochester, New York, 14642, USA.
authors: Armando
authors: A
authors: Villareal
authors: Department of Pathology and Laboratory Medic, University of Rochester, New York, 14642, USA.
authors: Tai C
authors: TC
authors: Kwong
mesh_terms: D000279:Administration, Cutaneous; D000286:Administration, Sublingual; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000652:urine*; D002047:Buprenorphine / Q000008:administration & dosage* / Q000652:urine*; D002853:Chromatography, Liquid / Q000592:standards; D059350:Chronic Pain / Q000188:drug therapy / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000592:standards; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000652:urine; D053719:Tandem Mass Spectrometry / Q000592:standards; D016896:Treatment Outcome; D016482:Urinalysis / Q000592:standards
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine
keywords: Buprenorphine; Chronic Pain; Urine Drug Tests