Study Highlights Prevalence of Buprenorphine “Spiking” in Urine Screenings for OUD Patients

More than 7% of urine samples collected in a cross-sectional study conducted by researchers from the University of Colorado School of Medicine, Johns Hopkins Bloomberg School of Public Health, and Millennium Health showed evidence of buprenorphine “spiking”—the intentional addition of buprenorphine tablet or residue directly into urine to mimic prescription adherence by opioid use disorder (OUD) patients.

Findings from the study were published this month in JAMA Psychiatry.

From January 2017 to April 2022, researchers collected 507,735 urine samples from 58,476 OUD patients. Samples were obtained from a national database of urine drug test specimens ordered by clinicians from primary care, behavioral health, and substance use disorder treatment clinics.

The researchers analyzed norbuprenorphine and buprenorphine concentrations. For patients prescribed buprenorphine for OUD, a norbuprenorphine-to-buprenorphine urinary ratio of <0.02 suggests spiking. Of the samples analyzed, 7.6% had evidence suggestive of spiking. The specimens suggestive of spiking were more likely to be positive for nonprescribed opioids and more likely to have been obtained from primary care clinics.

In a news release, Jarratt D. Pytell, MD, University of Colorado School of Medicine Department of Medicine, called the study’s results “tremendously timely,” given the recent removal of the X-waiver requirement, which called for practitioners to submit a notice of intent to prescribe medications, including buprenorphine, for OUD.

“This study highlights some of the complexities of prescribing buprenorphine,” Dr Pytell said. “New prescribers of buprenorphine will need to learn how to conduct the increasingly complex initiation of treatment and then gauge whether it is successful or not. Spiking suggests that treatment is not working—especially in patients continuing illicit drug use. Detecting spiking allows clinicians to adjust or intensify the treatment plan.” 

References

Clinicians identify buprenorphine “spiking” in JAMA Psychiatry study supported by Millennium Health researchers. News release. Millennium Health. March 22, 2023. Accessed March 28, 2023.

Pytell JD, Whitley P, Passik SD, et al. Association of Patients’ Direct Addition of Buprenorphine to Urine Drug Test Specimens With Clinical Factors in Opioid Use Disorder. JAMA Psychiatry. Published online March 22, 2023. doi:10.1001/jamapsychiatry.2023.