Can tramadol give a false positive result for buprenorphine in drug tests?

Tramadol Can Cause False-Positive Buprenorphine Results in Certain Immunoassays

Yes, tramadol can cause false-positive results for buprenorphine in some urine drug tests, particularly with certain point-of-care immunoassays and when using lower cutoff thresholds. 1

Evidence on Tramadol and False-Positive Buprenorphine Results

• Research has specifically demonstrated that tramadol use can cause false-positive urine buprenorphine immunoassay results, with the effect being assay-dependent 1
• In a study examining 29 urine samples from patients taking tramadol, 10 samples tested positive for buprenorphine by at least one immunoassay, with 7 confirmed to be false-positives when tested by liquid chromatography-tandem mass spectrometry (LC-MS-MS) 1
• The likelihood of false-positives appears to depend on the specific assay and cutoff threshold used:
  • No false-positives were detected with the ACON assay (10 ng/mL cutoff) 1
  • The Cedia assay showed false-positives when using a lower 5 ng/mL cutoff but not when using a 20 ng/mL cutoff 1

Understanding Drug Test Limitations and Cross-Reactivity

• Standard urine drug screens typically use immunoassays that, while sensitive, are susceptible to cross-reactions resulting in false-positive results 2
• Many providers have inadequate training in interpreting urine drug test results, and the ramifications of incorrect interpretation can be severe 3
• Preliminary screening tests are generally more prone to false positives compared to confirmatory tests 4

Best Practices for Accurate Interpretation

• When unexpected results occur, clinicians should consider a broad differential diagnosis before taking action 3
• Confirmatory testing using more specific methods like gas chromatography/mass spectrometry (GC/MS) is recommended when immunoassay results are unexpected or could impact patient management 3
• Healthcare providers should establish a working relationship with their local toxicologist who can consult on results interpretation 3

Important Considerations for Clinicians

• False-positive results can have serious consequences in clinical settings, potentially leading to inappropriate treatment decisions or unwarranted suspicion of substance misuse 3
• Other medications have also been reported to cause false-positive buprenorphine results, including amisulpride and sulpiride 5
• When interpreting urine drug test results, clinicians should be familiar with the specific drugs included in the testing panels used in their practice 3

Preventing Misinterpretation

• Universal drug testing protocols applied to all patients receiving controlled substances helps reduce stigma and prevent bias 3
• Explaining to patients that urine drug testing is intended to improve their safety and discussing expected results before ordering tests can improve the therapeutic relationship 3
• When unexpected results occur, discussing them with the laboratory or toxicologist is advised 4

In clinical practice, if a patient taking tramadol tests positive for buprenorphine and denies using this medication, confirmatory testing with more specific methods like LC-MS-MS should be considered before making any clinical decisions based on the result 1.