#13: Testing Positive for Suboxone and Illicits Simultaneously

June 28, 2019 Archived Blog Posts

“Why are many of our patients testing positive for drugs such as Cocaine, Meth and THC, if they are appropriately positive for the Suboxone we are prescribing?” was a question I received this past week.  Prior to answering, I hesitated for a moment since, after all, this was a clinic that treated addicts.  Surely they know addicts use illicit drugs.  The light went on and I realized what they were really asking.  (Stop laughing!)  If our patients are taking their suboxone correctly, why are so many still testing positive for illicit drugs?  WOW!  What a great question.  Although many might scoff at this, stating the answer is blatantly obvious, without the education regarding MAT (medically assisted treatment), it is not.  In fact, as I ruminated over this, I concluded other than our scientists, most of my laboratory staff would have this same question.  Suboxone (Buprenorphine and Naloxone) is a FDA approved drug used in MAT programs to treat opioid abuse.  In other words it tends to block the desired effects of opioids on certain brain receptors, but does not interfere with the effect of the other previously mentioned drugs.  If a patient is being prescribed Suboxone, they can be abusing cocaine, methamphetamine or cannabis at the same time the Suboxone is helping them refrain from using opioids.  The type of therapy an addict may receive when going to “treatment” may differ depending upon the type of drug they tend to abuse. 

Pharmacotherapy has been around for a long time.  Antabuse, a drug used for alcoholics, for instance, has been available for over 50 years.  The alcoholic knows the reaction they will have if they drink alcohol will be so bad, they refrain.   Currently there are no FDA approved medications to treat cocaine, meth and cannabis dependence.  This does not mean that providers are not using drugs that have been found helpful in the treatment of these drugs.  In fact there is the real possibility of the approval of a vaccine for cocaine on the near horizon, which stimulates an antibody response that binds to cocaine molecules causing them to be too large to cross the blood-brain barrier, which nullifies the effect of the drug.  There are many different drugs legally used off market (not for their clinically tested purpose) by providers, to decrease the withdrawal of certain addictions.  With problems comes the pathway to solutions!  I can’t emphasize enough the value of running appropriate confirmation drug tests when a patient is being treated with medications for their drug of choice. 
Please use ILDP as a resource if you have any questions regarding testing or common trends we see.

As you enjoy this Friday, remember we don’t know the motives or circumstances that cause another’s behavior.  Drug seekers and addicts affect everyone around them.  When we hold onto resentment and blame, even for the patients we treat, we are filled with the same.  Booker T Washington said, “You can’t hold a man down without staying down with him.”  Have a great weekend and thank you all for your business. 

Lance Benedict
President/CEO Industry Lab Diagnostic Partners