Blog: Why Drug Test

“Every so often one of my established office-based buprenorphine (Suboxone) patients gets a little rebellious about being asked to take drug tests. They feel since they’ve been doing so well for so long, they no longer need urine drug tests. They say things like, “Don’t you trust me by now?” But it’s not about them or their character. It’s about the disease of addiction. I tell them some abbreviated form of the following:

  • Patients in treatment don’t always tell me when they’ve relapsed.
  • It’s good medical practice.
  • There’s a gold mine of information in relapses.
  • Drug screening benefits the patient by giving them accountability.
  • Drug screening also shows them I’m serious about their recovery.
  • It’s the standard of care.

Source: JanaBurson – August 31, 2013

RI Hospital: Use of PMP May Increase Demand for Drug Treatment, Reduce Painkiller Abuse

A Rhode Island Hospital researcher has found that the use of electronic prescription drug monitoring programs (PMPs) may have a significant impact on the demand for drug treatment programs and how prescribers detect and respond to abuse of painkillers. The study by Traci C. Green, PhD, MSc, research scientist in Rhode Island Hospital’s department of general internal medicine is published in the journal Pain Medicine.The study found that prescribers’ use of an electronic PMPs may influence medical care and decisions, especially with opioid abuse detection, and is associated with clinical responses to suspected doctor shopping or diversion.

When prescribers suspected a patient of doctor shopping or diverting medications, PMP users were more likely to ramp up clinical monitoring with urine drug screens or refer the patient to drug treatment. PMP users were also less likely to ignore the warning signs or to call law enforcement.

“One thing is clear,” Green said, “Clinicians, not law enforcement, have the medical and behavioral health care expertise to guide patients struggling with addiction to get the help they need, when they are ready for it. PMPs can be an important clinical tool to address possible addiction issues and start that conversation.”

Green added, “Our study suggests that if states want wider use of PMPs by their prescribers, we need to increase access to drug treatment, especially opioid-dependence treatment options, if we are going to make headway on the epidemic of painkiller abuse and overdose death in our communities.”

Source: – Lifespan – August 16, 2012

CESAR FAX Publishes Report Warning of Emerging Epidemic of Buprenorphine Misuse

Prior research has shown that criminal offenders’ drug test results can help identify emerging drug epidemics well before they become evident in surveys and other community indicators. CESAR staff recently pilot tested the Adult Offender Population Urine Screening (OPUS) Program in Maryland as a rapid, low-cost tool for detecting and assessing emerging local drug trends.

In 2008, 1,061 urine specimens* originally collected and screened for 5 or fewer drugs by Maryland Division of Parole and Probation (DPP) agents were systematically sampled and sent to an independent laboratory for expanded testing for 31 drugs. The results showed an increase in the percentage of persons testing positive for buprenorphine since a smaller 2005 pilot study, and that these specimens often contained other drugs, suggesting possible misuse. Of the 98 specimens that tested positive for buprenorphine, 45% also contained two or more additional drugs and more than 60% contained other opioids (data not shown).

The drugs most frequently found were morphine (45%), cocaine (27%), marijuana (19%), and benzodiazepines (19%; see figure below).  Both other opioids and benzodiazepines could have lethal consequences if used with buprenorphine1.

A unique benefit of OPUS is that it enables the identification of local areas where drug misuse may be emerging. Once specific hot spots are identified, follow-up interviews can provide concrete details about substance use that can be used to guide criminal justice and public health efforts. CESAR staff conducted interviews in 2010 with 15 supervisees in one of the six probation offices close to Baltimore that submitted a high percentage of buprenorphine- positive specimens. The supervisees reported wide-spread availability of buprenorphine in the street and in prisons. While the most frequently mentioned reason for using buprenorphine was for self-medication to manage withdrawal symptoms, several participants mentioned that buprenorphine could be used to get high or to enhance the effects of other drugs. Additional reports of the smuggling of buprenorphine into jails and diversion of the drug to the street have also been reported across the country2.

The Maryland Adult OPUS findings, combined with national indicators of increased buprenorphine availability, diversion, and nonmedical use, suggest that there may be an epidemic of buprenorphine misuse emerging across the U.S. Unfortunately, “current testing protocols do not routinely include buprenorphine and cannot inform us of the magnitude and scope of buprenorphine misuse. Thus, offenders smuggle the drug into jails and prisons because its use will go undetected and buprenorphine-related deaths cannot be tracked because medical examiners and coroners do not routinely test for the drug in most states” (p. 6).

The authors recommend that “buprenorphine be added to all relevant drug testing regimens, if only to gauge the extent of diversion and misuse” (p. 6). In addition, the authors suggest that physician education programs “redouble their efforts to teach strategies to deter diversion and misuse of the drug” (p. 3) and that doctors closely monitor dosing “to ensure that the appropriate amount is prescribed, thereby reducing the likelihood of diversion” (p. 6). The OPUS model could be easily replicated in other states interested in tracking emerging prescription and other drug problems.

Percentage of Buprenorphine-Positive Specimens Testing Positive for Other Drugs, 2008 (N=98)


*To enhance the likelihood of detecting less commonly used drugs, we targeted random samples of 15 drug-positive specimens and 5 drug-negative specimens submitted by each DPP office.

1) Reckitt Benckiser Pharmaceuticals Inc., Suboxone Tablet Product Information, 2012. Available online at:  2) CESAR FAX, Volume 20, Issue 33 and CESAR FAX Buprenorphine Series, 2012. Available online at

Source: Adapted by CESAR from Wish, ED, Artigiani, E, Billing, A, Hauser, W, Hemberg, J, Shiplet, M, and DuPont, R, “The Emerging Buprenorphine Epidemic in the United States,” Journal of Addictive Diseases 31(1):3-7, 2012. Available online at:

Soldiers to be Tested for Prescription Drug Abuse

The Army will soon begin expanded testing of Soldiers for unauthorized prescription drugs, in addition to currently tested illegal substances.

“We’re starting with hydrocodone and hydromorphone as the first expansion” of testing said Lt. Col. Shaun Bailey, chief of the drug testing branch at the Army Center for Substance Abuse Programs. He explained that these two pain-killers are widely used, as they are found in Vicodin and other brand-named drugs.

“We will continue to expand and increase our prescription drug-testing capabilities in the months to come,” Bailey said. “We’re not limiting ourselves in this initial announcement.” The expanded testing of urinalysis samples will begin around May 1 and ramp up as more labs come online, Bailey said. The program will be fully implemented Army-wide by Oct. 1 as part of the Army’s crackdown on prescription drug abuse.

Source: United States Army – February 27, 2012

DOD Adds Vicodin, Xanax to Drug Testing, Offers 90-day Amnesty

The Defense Department announced an expansion of its drug testing program to include widely abused prescription medications containing hydrocodone and benzodiazepine, but it’s offering an unprecedented 90-day amnesty period for service members to come clean or get treatment.

Source: Stars and Stripes – February 2, 2012

Nearly 50 Attica, New York Inmates Falsely Test Positive for Suboxone Use

A total of 57 inmates tested positive for the use of Suboxone, a drug containing buprenorphine, a medication used to treat opiate addiction.

Inmates testing positive were subject to disciplinary hearings that resulted in many cases, solitary confinement, the loss phone use and commissary privileges, loss of family visitation and loss of accrued “good time status”, which can affect parole hearing outcomes.

After nearly a month of complaints, the Superintendent of Attica contacted the manufacturer of the drug testing equipment, who, after testing, found it to be mis-calibrated, leading to the false-positive results.

As a result, 48 of the 57 prisoners who tested positive for Suboxone will have their positive test reversed and have imposed sanctions reversed.

Source: Buffalo, New York  – January 21, 2012

Congress O.K.’s Drug-Testing the Unemployed: Will It Fight Addiction?

Last week, in a deal to maintain the payroll tax cut and extended unemployment benefits, the United States Congress passed a law that allows states to drug-test people seeking unemployment benefits, if they were fired from their last job for drugs, and anyone seeking jobs that would ordinarily require a drug test.

Republicans initially wanted to drug-test all people applying for unemployment benefits — a measure Democrats opposed. It’s not clear how many states will start testing under the new compromise law, or what percentage of the unemployed will end up having to pee in cups, but if the intent of the policy is to reduce addiction rates, the research suggests it isn’t going to work. In fact, the new law might even increase certain types of drug use.

Source: – January 21, 2012

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