Does Suboxone (buprenorphine/naloxone) show on urine toxicology screens?

From the Guidelines

Suboxone does show up on urine toxicology tests, but it requires specific testing to detect it. According to the guidelines, initial urine drug testing can be performed with a relatively inexpensive immunoassay panel for commonly prescribed opioids and illicit drugs, but patients prescribed less commonly used opioids, such as buprenorphine (the main active ingredient in Suboxone), might require specific testing for those agents 1. The use of confirmatory testing adds substantial costs and should be based on the need to detect specific opioids that cannot be identified on standard immunoassays or on the presence of unexpected urine drug test results.

Some key points to consider when testing for Suboxone include:

• Standard or basic drug panels typically do not detect buprenorphine, so a specialized test is needed to screen for it and its metabolites.
• Suboxone can be detected in urine for approximately 7-10 days after last use, though this timeframe varies based on factors like dosage, frequency of use, metabolism, and hydration levels.
• Patients prescribed Suboxone for opioid use disorder should always inform testing facilities or employers about their legitimate prescription to avoid misinterpretation of positive results.
• The naloxone component in Suboxone is generally not tested for in standard urine screens. Clinicians should be familiar with the drugs included in urine drug testing panels used in their practice and should understand how to interpret results for these drugs, as noted in the guidelines 1.

From the Research

Suboxone Detection in Urine Toxicology

• Suboxone, a formulation containing buprenorphine and naloxone, can be detected in urine toxicology tests 2, 3, 4, 5.
• Studies have shown that urine drug testing can accurately identify the use of specific prescription medications, including buprenorphine, and illicit substances 6.
• The sensitivity and specificity of urine buprenorphine tests have been reported to be high, with a sensitivity of 100% and specificity of 87.5% in one study 2.
• Urine buprenorphine concentrations can vary widely, with reported averages ranging from 164 ng/mL to over 1000 ng/mL 2, 4.
• Factors such as patient age, sex, and clinical setting can influence the likelihood of detecting buprenorphine in urine specimens 5.

Urine Testing Methodologies

• Definitive urine drug testing, which uses liquid chromatography-mass spectrometry (LC-MS-MS), can provide accurate and reliable results 6, 2.
• Immunoassay tests, such as the CEDIA buprenorphine assay, can also be used to detect buprenorphine in urine, but may have lower sensitivity and specificity compared to LC-MS-MS 2.
• The norbuprenorphine to buprenorphine ratio can be used to identify adulterated urine specimens, with a ratio of less than 0.02 suggesting direct addition of buprenorphine to the specimen 4, 5.

Clinical Implications

• Urine drug testing is an important tool for monitoring medication adherence and patient stability in office-based opioid treatment settings 6, 3.
• Clinicians should be aware of the potential for patients to adulterate their urine specimens, either by adding buprenorphine or other substances, and take steps to prevent and detect such behavior 4, 5.
• The interpretation of urine buprenorphine test results should take into account individual patient factors, such as age, sex, and clinical setting, as well as the testing methodology used 5.